The First Week and Beyond

Lexapro (escitalopram) is a type of antidepressant medication known as a selective serotonin reuptake inhibitor or SSRI. That means it works by blocking the reuptake of serotonin, making more of that neurotransmitter available in the brain. Lexapro 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)—or the brand name Cipralex if you are in the UK—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 side effects during the first week of treatment. During your first week of taking Lexapro, some of the most common side effects you might experience include:

• Diarrhea
• Dry mouth
• Fatigue
• Headaches
• Increased sweating
• Nausea
• Nervousness
• Restlessness
• Trouble sleeping

While you might be experiencing some side effects during your first week of taking Lexapro, you may also feel relief from physical symptoms of your mental health condition, such as improved energy and appetite. 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

It’s important to remember that side effects are normal and even expected. Roughly 75% of people taking antidepressant medications experience some type of side effects.

Some of the most common side effects people experience while taking Lexapro are:

• Drowsiness or fatigue
• Increased sweating
• Insomnia
• Nausea
• Sexual issues (such as ejaculation disorder and decreased libido)

It is important to know that these side effects may appear within the first two weeks of taking the medicine and subside as your body adjusts to it. 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

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. This is of particular concern in children, adolescents, and young adults—especially when beginning treatment or changing the dosage.

Warning signs to watch for include new or sudden changes in mood, behavior, actions, thoughts, or feelings. Someone who is considering suicide may talk about feeling trapped or a burden to others, increase their drug or alcohol use, isolate from others, or change their sleep patterns, among other actions.

Lexapro Drug Interaction Side Effects

Taking Lexapro with other medications, supplements, or substances can also lead to unpleasant or potentially dangerous drug interactions. 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.

Serotonergic Medication

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

Medications that may increase the risk of serotonin syndrome include:

• Antibiotics, like Zyvox (linezolid)
• Anti-nausea medicines, including Zofran (ondansetron) and Reglan (metoclopramide)
• Dietary supplements, namely tryptophan
• Herbal supplements, like St. John’s wort and ginseng
• HIV and AIDS medications, such as Norvir (ritonavir)
• Illegal substances, including cocaine and amphetamines
• Other SSRIs, such as Celexa (citalopram) and Prozac (fluoxetine)
• Monoamine oxidase inhibitors (MAOIs), like Emsam (selegiline) and Nardil (phenelzine)
• Mood stabilizers, such as lithium
• Norepinephrine reuptake inhibitors, such as Wellbutrin (bupropion)
• Over-the-counter cold and cough medicines that contain the ingredient dextromethorphan
• Pain medications, like Ultram (tramadol) and Oxycontin (oxycodone)
• Serotonin-norepinephrine reuptake inhibitors (SNRIs), such as Cymbalta (duloxetine) and Effexor (venlafaxine)
• Tricyclic antidepressants, such as Pamelor (nortriptyline) and Elavil (amitriptyline)
• Triptans used for treating migraines, such as Imitrex (sumatriptan) and Axert (almotriptan)

Coping With Lexapro Side Effects

Lexapro’s side effects can sometimes be a bit unpleasant at first, but they are usually mild. In other words, they can be annoying at first, but they can be managed fairly easily. Talk to your doc about some of the things you can do to feel better until the worst of the side effects start to wear off. Som strategies they might suggest include:

• 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 your 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 physician’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

Always follow your doctor’s directions when taking Lexapro. The usual recommended daily dosage is 10 milligrams (mg). Doses higher than 20 mg are not approved by the FDA. You may take Lexapro as a tablet or an oral solution once daily, in the morning or evening, with or without food.

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

Precautions When Taking Lexapro

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 also 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 care provider if you are allergic or hypersensitive to escitalopram oxalate or if you are pregnant or breastfeeding. It’s also important to alert them if you have a history of any of the following medical conditions:

• Bleeding problems
• Glaucoma
• Heart disease or heart attack
• Kidney or liver disease
• Low sodium levels (hyponatremia)
• Seizures

Lexapro Withdrawal Side Effects

Once you start taking Lexapro, you shouldn’t stop taking it without talking to your doctor first. It’s never a good idea to stop your medication abruptly as this may cause you to experience withdrawal symptoms, such as:

• Agitation and irritability
• Anxiety
• Burning, numbness, or tingling in the hands or feet
• Confusion
• Dizziness
• Headaches
• Nausea
• Shaking
• Sleep issues
• Sweating
• Tiredness

To reduce the risk of these effects, your doctor may reduce your dosage over the course of several days before discontinuing the medicine altogether. Tapering your medication slowly allows your body to adjust and minimizes the risk of withdrawal effects.

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 Seek Medical Attention

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 physician may decide to adjust your dosage or switch you to another medication entirely.

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