Lexapro Side Effects: What Are They?
Dr. Angel Rivera
Depression and anxiety are part of the rising occurrence of mental illness in the United States, with an estimated 17.3 million American adults experiencing a major depressive episode lasting two or more weeks each year and more than 40 million adults diagnosed with an anxiety disorder. Lexapro is a popular drug used to treat certain types of anxiety and depression; Lexapro reports fewer side effects than other drugs in its class of medications. As work-life balance issues continue and Americans find themselves more stressed-out than ever, taking medications like Lexapro to treat anxiety and depression can help people find relief from symptoms and get their lives back. Lexapro is not right for everyone, but it can be extremely helpful for people who respond well to the medication. Lexapro is approved for use in both adults and adolescents under certain conditions.
Also known under the generic name escitalopram, Lexapro belongs to a class of antidepressant medications known as selective serotonin reuptake inhibitors (SSRIs). Since the first SSRI was approved in 1986, the medication has become one of the most commonly prescribed classes of drugs in the United States. Lexapro is a popular and often prescribed medication in the United States; nearly 26 million prescriptions were written for Lexapro in 2017, making it the 20th most prescribed medication in the United States that year.
Lexapro was first approved by the Food and Drug Administration (FDA) in 2002 for the treatment of major depressive disorder (MDD) and generalized anxiety disorder in adults. In March of 2009, the FDA also approved the medication for the treatment and management of major depressive disorder in adolescents between the ages of 12 and 17, making it only the second antidepressant in the United States approved for the treatment of MDD in adolescents. A brief explanation and list of symptoms associated with major depressive disorder and generalized anxiety disorder are described below.
Clinical Depression/Major Depressive Disorder
Clinical depression, also known as major depressive disorder, is characterized by persistent and intense feelings of sadness that last for extended periods of time - at least two weeks or more. Depression has mental manifestations that impact your behavior and mood, but it can also cause physical issues as well, including loss of appetite and changes in sleep. People who experience major depressive disorder may lose interest in doing activities that they once enjoyed or have trouble performing everyday activities, and they may have suicidal thoughts and tendencies. About seven percent of American adults have an episode of clinical depression each year, making it one of the most common mental health issues in the U.S. Symptoms of major depressive disorder include:
- Feelings of worthlessness, guilt, hopelessness, or helplessness
- Feeling sad, empty, or tearful
- Difficulty concentrating and low energy
- Lost of interest in activities you used to enjoy
- Feelings of moving or thinking in slow motion
- Sleeping and eating more or less than usual
- Nervous energy
- Suicidal thoughts or behaviors
- Generalized Anxiety Disorder
In addition to depression and major depressive disorder, Lexapro also treats generalized anxiety disorder (GAD). Everyone experiences anxiety at different points during their lifetimes, but anxiety is classified as a health problem when the feelings become extreme, last six months or more, and interfere with your quality of life. Anxiety is the body’s natural response to stress and is defined by fear or apprehension about what is to come. Symptoms of generalized anxiety disorder can include restlessness, panic attacks, difficulty falling asleep, an increased heart rate, rapid breathing, and trouble concentrating.
How Lexapro Works
Lexapro belongs to a family of drugs called selective serotonin reuptake inhibitors (SSRIs), which work by blocking the absorption of serotonin, a neurotransmitter, in the brain. This action helps regulate the amount of serotonin in the brain, which helps brain cells transmit messages to each other, helping to improve and stabilize the mood. Lexapro also activates neurons in the hippocampus, which is a portion of the brain that is responsible for forming memories. When taking Lexapro, people who suffer from depression may experience an improved mood, regain interest in old hobbies that they once enjoyed, and feel the physical symptoms of depression, such as exhaustion and loss of appetite, ease.
Like most medications, the brand name form of Lexapro is substantially more expensive than the generic form of the drug, escitalopram. While escitalopram is typically covered by most Medicare and insurance plans, it may be possible to receive a cheaper price on the drug 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 Lexapro and escitalopram.
Costs of a 30-Day Supply of Lexapro and Escitalopram
5 mg oral capsules
10 mg oral capsules
20 mg oral capsules
Because there are many different manufacturers for escitalopram, the prices of the drug are extremely affordable even for those who are uninsured or underinsured. Although some people express concern over the quality of generic drugs, these concerns are unfounded; the FDA subjects generic forms of the medication to the same stringent testing as the brand name form of the drug. The generic medication uses the same active ingredient as the brand name form of the medication in the same amount, but may use different inactive ingredients that affect the color, size, shape, or taste of the medication. However, you will receive the same treatment when using a generic medication of the same form and strength as you would with a brand name medication.
Lexapro is one of the most popular SSRIs on the market for good reason - there are many benefits to using this medication! Benefits associated with the use of Lexapro include:
- The medication is highly effective at treating symptoms of depression and anxiety.
- Lexapro has the potential to be a short-term medication and helps to lower the likelihood that your depression will come back, which may mean you do not have to take it again in the future.
- Lexapro has fewer drug interactions than other medications in its class.
- Lexapro causes comparatively fewer side effects when compared to other drugs in its class.
Your doctor will determine the appropriate dose of Lexapro for you based on your age and the purpose of treatment, but your medication dose may have to be adjusted several times before you get it just right. The standard treatment for adults suffering from major depressive disorder starts at 10 mg per day, taken once daily. Doctors may increase your dose up to 20 mg, but this is generally considered the maximum dose. Patients being treated for anxiety also typically start at a dose of 10 mg, but may increase up to 20 mg at the doctor’s discretion. Lexapro is also available in a delayed-release oral capsule that is taken weekly. Lexapro is available in 5 mg, 10 mg, or 20 mg oral tablets or as an oral solution.
Patients who take Lexapro should not abruptly stop or change their dose without consulting with their doctor, as this can cause withdrawal symptoms if a patient has been using the medication for six weeks or more. Symptoms of Lexapro withdrawal include:
- Nausea and indigestion
- Feeling dizzy
- Return of depression or mood swings
What Are the Side Effects Associated with Lexapro?
While the side effects associated with Lexapro may be less than the side effects associated with other medications in the same drug class, numerous side effects do still exist. The side effects of Lexapro are slightly different for children and adults. Common side effects of Lexapro use in adults include:
- Weight gain
- Unusual changes in sex drive and other sexual issues like erectile dysfunction and premature ejaculation
- Dry mouth
- Trouble sleeping
- Loss of appetite
Children adolescents may experience the same possible side effects listed above for adults, but may also experience the following:
- Increased thirst
- Heavy menstrual periods
- Abnormal increase in muscle movement or agitation
- Trouble urinating
- Slowed growth and weight change or weight loss
- Rare but serious side effects associated with Lexapro include:
- Severe allergic reaction, as evidenced by:
- Breathing trouble
- Swelling of the face, tongue, eyes, or mouth
- Severe rash, hives, or blisters that may be accompanied by fever or joint pain
- Seizures or convulsions
- Low salt levels, as evidenced by:
- Trouble concentrating
- Irregular heartbeat
- Thinking or memory problems
- Unsteadiness that can lead to falls
Serotonin syndrome, as evidenced by:
- Severe muscular tightness
- Manic episodes, as evidenced by:
- Greatly increased energy
- Racing thoughts
- Unusually grand ideas
- Talking quickly or more than normal
- Severe sleeping trouble
- Reckless behavior
- Excessive happiness or irritability
- Vision problems, as evidenced by:
- Eye pain
- Changes in your vision
- Swelling or redness in or around your eye
- If you experience any of these side effects, please get medical attention immediately.
Are There Any Risks Associated with Lexapro?
Of the risks associated with taking Lexapro, the most significant is the increased risk of suicidal thinking, ideation, and behavior in children, adolescents, and young adults suffering from major depressive disorder; however, most antidepressants carry this same risk. Patients with a diagnosis of major depressive disorder should be closely monitored while taking Lexapro, especially if they are under the age of 24 or they have other medical conditions. If taken with other medications that impact the serotonin levels of the brain, Lexapro can also cause serotonin syndrome, a serious and potentially life-threatening complication.
Lexapro 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 (MAOs), especially Pimozide. Lexapro should not be taken by people who also take citalopram (Celexa). Patients and prescribers should exercise care when using the drug in conjunction with benzodiazepines and other drugs that affect the central nervous system, such as Ativan and Klonopin. When combined with over-the-counter non-steroidal anti-inflammatories (NSAIDs) like ibuprofen, blood thinners, or other prescription drugs that affect blood coagulation, Lexapro can lead to an increased risk of bleeding. Additionally, Lexapro should not be used with antipsychotic drugs or other SSRIs or herbs that are serotonergic. Lexapro has been reported to activate mania in people considered susceptible to the condition.
Who Should Not Take Lexapro?
People who take certain types of drugs known to cause dangerous interactions with Lexapro, including MAOIs, pimozide (Orap) or citalopram (Celexa), blood thinners such as warfarin and blood pressure medications, nonsteroidal anti-inflammatory drugs (NSAIDs) and aspirin, and other drugs used to increase the level of serotonin in your body, should use caution when considering taking Lexapro and should make sure to give their healthcare provider a complete medical history. People who are allergic to Lexapro or its active ingredient, escitalopram, should not take the medication.
People with certain personal medical histories or family medical histories should use caution when considering taking Lexapro. Be sure to give your doctor a complete medical history, especially including any personal or family history examples of the following conditions:
- Bipolar or manic-depressive disorder, as Lexapro may trigger a manic episode when taken without other medications for bipolar disorder
- Personal or family history of suicide attempts, as Lexapro can increase the risk of suicidal behavior, thoughts, and ideation, especially in people under the age of 24
- Seizures, as Lexapro can cause seizures and worsen seizure disorders in people prone to seizures
- Glaucoma, as Lexapro can cause a glaucoma attack
- Low salt levels, as Lexapro can reduce your sodium levels
- Heart or liver problems
- Older adults are more likely to experience side effects, including an increased risk of bleeding and loss of coordination; loss of coordination increases the risk of falling. Older adults are also considered to be at increased risk of developing low blood sodium, so please seek medical advice regarding your treatment options.
Is Lexapro Safe for Pregnant and Nursing Women?
Lexapro is not considered safe for pregnant women and should only be taken during pregnancy if the potential benefits outweigh the potential for risks to the fetus. Lexapro has been found to increase the risk of serious lung problems and other complications in developing fetuses. However, it is important not to start or stop Lexapro during pregnancy without your doctor’s guidance, as abruptly stopping your medication can cause a relapse of depression.
Because Lexapro can be passed into breast milk, use by nursing mothers is not advised.