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Escitalopram: Uses, Side Effects, Dosages, and More

Depression and anxiety disorders affect nearly 60 million adults in the United States each year, with an estimated 17.3 million American adults experiencing a major depressive episode lasting two or more weeks each year. 

Escitalopram, which was first introduced in 2002, has rapidly become one of the most popular prescription medications for the treatment of certain types of depression and anxiety. 

Escitalopram can be used to treat both adults and adolescents, and while the drug isn’t right for everyone, it has helped millions of people find relief from their symptoms of depression and anxiety.

What is escitalopram?

Escitalopram is a generic prescription drug that belongs to a newer class of antidepressants called selective serotonin reuptake inhibitors (SSRIs). SSRIs were first introduced to the market in 1986 and have since largely replaced older antidepressant medications, including tricyclic antidepressants and MAOIs, due to their lower incidence of severe side effects. 

Escitalopram is well known by its brand name, Lexapro, and is one of the most popular prescription medications and antidepressants in the United States. Nearly 26 million prescriptions were written for escitalopram in 2017, making it the 20th most prescribed medication in the United States that year.

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What conditions are treated with escitalopram?

The U.S. Food and Drug Administration (FDA) first approved escitalopram in 2002 under the brand name Lexapro. From 2002 to 2009, the drug was approved for the treatment of major depressive disorder (MDD) and generalized anxiety disorder in adults only. 

The medication was approved for the treatment of major depressive disorder in adolescents between the ages of 12 and 17 in March of 2009, which made the drug only the second antidepressant in the United States approved for the treatment of major depressive disorder in adolescents. It has also been used to treat anxiety, obsessive-compulsive disorder, and panic disorders including panic attacks.

How does escitalopram work?

Selective serotonin reuptake inhibitors (SSRIs) like escitalopram help to improve symptoms of depression and anxiety by stabilizing the levels of serotonin, a type of neurotransmitter, in the brain. 

Specifically, escitalopram works by preventing the reuptake of serotonin, which causes the levels of the neurotransmitter to increase. Serotonin is a neurotransmitter that plays a role in elevating and stabilizing mood. 

Patients who use escitalopram for the treatment of major depressive disorder may find that their mood improves, they no longer experience physical symptoms of depression like changes in sleep and appetite, and they begin to enjoy old hobbies again.

How much does escitalopram cost?

As a generic drug, escitalopram is priced much more affordably than its brand-name counterpart, Lexapro. Most commercial health insurance plans, Medicaid, and Medicare cover the cost of escitalopram, while Lexapro is likely not to be covered unless there is a clear medical need for the brand-name medication. 

Regardless of whether you choose to take escitalopram or Lexapro, it is possible to save on the cost of your medication by using a pharmacy discount card or coupon or paying the cash price. The following table compares the costs of a 30-day supply of escitalopram and Lexapro.

Costs of a 30-Day Supply of Lexapro and Escitalopram

 

5 mg oral capsules

10 mg oral capsules

20 mg oral capsules

Lexapro

$363.60

$248.16

$103.77

Escitalopram

$13.12

$13.29

$13.20

Escitalopram is produced by a large number of manufacturers, which means that the drug is generally affordable regardless of the amount of prescription drug coverage a patient may have under their plan. Generic medications contain the same active ingredients as their brand-name versions. The FDA requires that generic drugs be subject to the same rigorous standards and testing as brand-name drugs. 

How do I know which dose of escitalopram to take?

The right dose of escitalopram for you will depend on your age and the reason why you are taking the drug. Antidepressants like escitalopram affect everyone differently, so the dose that works for someone your age with the same condition may not be right for you. 

As a result, your doctor may need to adjust your dose of the medication several times before you find the dose that works best for you. Adults with major depressive disorder typically start taking escitalopram at a dose of 10 mg taken once per day by mouth. The maximum dose of escitalopram for adults with depression is 20 mg.

Patients who are being treated for anxiety typically start at a dose of 10 mg taken by mouth once per day. The maximum dose of escitalopram for generalized anxiety disorder is 10 mg per day. Escitalopram is available in 5 mg, 10 mg, or 20 mg oral tablets.

Escitalopram can cause withdrawal symptoms in patients who have been taking the medication for at least four to six weeks. Therefore, patients who have been taking the drug for four to six weeks or more should not abruptly stop or change their dose without consulting with their doctor. 

Symptoms of escitalopram withdrawal may include:

  • Irritability

  • Nightmares

  • Headache

  • Paresthesia

  • Nausea 

  • Dizziness

  • Vomiting

  • Depression or mood swings

What are the side effects associated with escitalopram?

SSRIs like escitalopram are all associated with an extensive list of side effects due to their action on brain chemistry. However, the side effects associated with escitalopram may be better tolerated than the side effects associated with other SSRIs. The side effects of escitalopram are slightly different for children and adults.

Common side effects of Escitalopram use in adults include:

  • Nausea

  • Shaking

  • Dry mouth

  • Infection

  • Sweating

  • Loss of appetite

  • Constipation

  • Weakness

  • Unusual changes in sex drive and other sexual issues like erectile dysfunction and premature ejaculation 

  • Sleepiness

  • Dizziness

  • Trouble sleeping

  • Yawning

Children and adolescents may experience the same possible side effects listed above for adults, but may also experience the following:

  • Trouble urinating

  • Slowed growth and weight change or weight loss

  • Heavy menstrual periods

  • Abnormal increase in muscle stiffness, movement or agitation

  • Increased thirst

  • Nosebleeds

Rare but serious side effects associated with escitalopram include:

  • Suicidal thoughts and behaviors

  • Risk of bleeding, especially abnormal bleeding

  • Severe allergic reactions with symptoms such as:

    • Difficulty breathing

    • Severe rash, hives, or blisters that may be accompanied by fever or joint pain

    • Swelling of the face, tongue, eyes, or mouth

  • Seizures or convulsions

  • Low salt levels, which can cause symptoms such as:

    • Confusion

    • Headache

    • Trouble concentrating

    • Weakness

    • Memory problems

    • Unsteadiness that can lead to falls

  • Serotonin syndrome, which can cause symptoms such as:

    • Severe muscular tightness

    • Fever

    • Shivering

    • Diarrhea

    • Confusion

    • Seizures

  • Manic episodes, which can cause symptoms such as:

    • Unusually grand ideas

    • Reckless behavior

    • Excessive happiness or irritability

    • Talking quickly or more than normal

    • Greatly increased energy

    • Racing thoughts

    • Trouble sleeping

  • Vision problems, which can cause symptoms such as:

    • Eye pain

    • Swelling or redness in or around your eye

    • Changes in vision

Patients experiencing any of these side effects should seek medical attention immediately. This may not be a complete list of side effects. Consult a healthcare professional for other possible side effects associated with escitalopram. 

Are there any risks associated with escitalopram?

Use of escitalopram is associated with warnings and precautions, the most significant of which is the increased risk of suicidal thinking, ideation, and behavior in children, adolescents, and young adults who are taking the medication for the treatment of major depressive disorder. While this is a serious risk, it should be noted that most antidepressants carry this same risk. 

Young adults, adolescents, and children under the age of 24 or who have other medical conditions while taking escitalopram for major depressive disorder should be closely monitored while using the medication. When escitalopram is combined with other medications that influence the levels of serotonin in the brain, it can cause a condition called serotonin syndrome that is serious and potentially life-threatening.

Escitalopram has the potential for serious drug interactions and should not be taken in conjunction with or within fourteen days of the use of monoamine oxidase inhibitors (MAOIs) such as tranylcypromine, isocarboxazid, phenelzine, and selegiline. Individuals who are allergic to Celexa (also sold under the generic name citalopram) may experience an allergic reaction to escitalopram. 

Patients need to use caution when combining escitalopram with the following drugs:

·       Central nervous system depressants

·       Non-steroidal anti-inflammatories (NSAIDs) 

·       Blood thinners

·       Serotonergic drugs

This may not be a complete list of drug interactions. Consult a healthcare provider for other possible drug interactions associated with escitalopram.

Escitalopram has been reported to activate mania in people considered susceptible to the condition, including those with bipolar disorder who are not being treated with other medications.

Who should not take escitalopram?

Patients should give their healthcare provider a complete record of all prescription medications, over the counter drugs, herbs, dietary supplements, and recreational drugs that they use in order to avoid a potentially serious drug interaction. People who are allergic to Lexapro or its active ingredient, escitalopram, should not take the medication.

Escitalopram is generally well tolerated and is considered a safe medication, but people with certain medical histories may not be able to use the medication safely. 

When talking to your healthcare provider about your potential use of escitalopram, be sure to give your doctor a complete medical history, including any personal or family history of the following conditions:

  • Bipolar or manic-depressive disorder, due to the potential of escitalopram to trigger a manic episode when taken without other medications for bipolar disorder

  • Suicidal thoughts or behaviors, due to the potential of escitalopram to increase the risk of suicidal behavior, thoughts, and ideation, especially in people under the age of 24

  • Seizures, due to the potential for escitalopram to cause seizures and worsen seizure disorders in people prone to seizures

  • Glaucoma, due to the potential for escitalopram to cause a glaucoma attack

  • Low salt levels, due to the potential of escitalopram to reduce sodium levels

  • Heart, kidney, or liver problems including high blood pressure

Older adults over the age of 65 are considered to be at increased risk of developing low blood sodium, so use of escitalopram may require careful monitoring in this population. 

Summary

Escitalopram is one of the most popular antidepressants on the market due in part to its tendency to cause fewer side effects than other drugs in its class like sertraline, paroxetine, and fluoxetine. It is thought to be safe for use during breastfeeding as there are only low levels present in breast milk when used by new mothers. 

The most common side effects associated with escitalopram include nausea, drowsiness and tiredness, weight gain, and decreased libido, but the medication is well tolerated when compared to other antidepressant medications. Seek medical advice to see if escitalopram is right for you. 

The medication is available in both generic and brand name forms, but patients can save significantly by choosing the generic form of the medication and purchasing their prescription with a pharmacy discount card from USA Rx

Sources:

https://www.webmd.com/drugs/2/drug-63990/lexapro-oral/details 

https://www.nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications/Types-of-Medication/Escitalopram-(Lexapro) 

https://www.healthline.com/health/depression/lexapro-side-effects

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