What is Lexapro® and what does it treat?
Escitalopram is a selective serotonin reuptake inhibitor (or “SSRI”) that is used to treat Major Depressive disorder (also, Major Depression or MDD). In addition, escitalopram is effective, and FDA approved, for the treatment of Generalized Anxiety Disorder (GAD). Key elements to both illnesses are that untreated symptoms remain in place over long periods of time, and that while untreated the person’s functioning in day–to–day life is significantly decreased.
Major Depression is when a person experiences several of the following symptoms at the same time: “low” or depressed mood (for example, sad, empty, tearful), decreased interest in most or all activities, changes in appetite (usually decreased), changes in sleep (usually poor sleep), loss of energy, feeling worthless/guilty/ hopeless/ helpless, difficulty concentrating, thoughts of death (suicidal thinking).
Generalized anxiety disorder is when a person experiences several of the following symptoms at the same time: excessive and difficult to control anxiety or worrying, feeling restless or “keyed–up” or “on edge”, becoming tired very easily, difficulty concentrating, irritability, muscle tension, and difficulty falling and/or staying asleep.
Escitalopram may be used for other anxiety or mood disorders such as panic disorder, social anxiety disorder, obsessive compulsive disorder, post-traumatic stress disorder or bipolar depression as determined by an individual’s health care provider.
What is the most important information I should know about Lexapro®?
- After starting an SSRI and taking it every day, symptoms usually begin to improve during the first 1–2 weeks. Maximal improvement is usually seen after 4–6 weeks. Once symptoms are under control, MDD and GAD usually require long-term treatment. Only your healthcare provider can determine the length of escitalopram treatment that is right for you.
- Do not stop taking escitalopram or change your dose without talking with your healthcare provider first.
- Stopping escitalopram abruptly can result in one or more of the following withdrawal effects: irritability, restlessness, dizziness, numbness, anxiety, confusion, headache, feeling tired, “shooting” pains in the arms or legs, and difficulty sleeping.
- Patients with Major Depression or other mental illnesses may sometimes think about, or attempt, suicide. Closely watch anyone taking antidepressants, especially early in treatment or when the dose is changed. Patients who become extremely irritable or anxious, or have new or increased thoughts of suicide or other changes in mood or behavior should contact their healthcare professional right away.
Children(18 years or younger) taking antidepressants experience suicidal thoughts or actions in about 1 out of every 50 who are depressed. Although escitalopram is often prescribed for children with Major Depression or anxiety disorders, the FDA has not approved escitalopram for use in this age group.
Adults: several recent scientific publications report the possibility of an increased risk for suicidal behavior in adults who are being treated with antidepressant medications. Even before these reports became available, FDA began a complete review of all available data to determine whether there is an increased risk of suicidal thinking or behavior in adults being treated with antidepressant medications.
It is expected that this review will take a year or longer to complete. In the meantime, FDA is highlighting that adults being treated with antidepressant medication, particularly those being treated for Major Depression, should be watched closely for worsening of Major Depression and for increased suicidal thinking or behavior.
- Because depression can also be a part of Bipolar illness, people who take antidepressants may be at risk for “switching” from depression into mania. Symptoms of mania include “high” or irritable mood, very high self esteem, decreased need for sleep, pressure to keep talking, racing thoughts, being easily distracted, frequently involved in activities with a large risk for bad consequences (for example, excessive buying sprees). Contact a healthcare professional immediately to prevent further worsening of symptoms.
- Escitalopram may interact with medications you are currently taking, or that may be added in the future. Be sure that you know all of your medications so that your doctor or pharmacist can know if any drug–drug interactions are occurring.
- You should not drink alcohol or use illegal drugs while taking escitalopram.
Are there specific concerns about Lexapro® and pregnancy?
If you are planning on becoming pregnant, notify your healthcare provider so that he/she can best manage your medications. People living with MDD or GAD who wish to become pregnant face important decisions, each with risks and benefits as it relates to how the illness, medications and the risks to the fetus may interact. This is a complex decision as untreated MDD or GAD has risk as well to mother and fetus. There are many dimensions to these choices, so be sure to confer with your doctor and caregivers.
Since escitalopram is a newer medication, there is less information about its use in pregnant women. Escitalopram has caused birth defects in animals, but there are no human studies. Most reports about SSRIs indicate that birth defects do not occur more commonly when compared with babies born to mothers taking no medications.
However, babies born to mothers who have taken SSRIs do seem to be at risk for withdrawal effects. These symptoms can include: breathing and eating difficulties, colicky symptoms, increased reflexes, increased or decreased muscle tone, irritability, constant crying, and seizures. Before your baby is born, you may wish to discuss the possibility of decreasing, and then stopping, escitalopram with your healthcare provider in order to decrease your baby’s risk of withdrawal.
For mothers who have taken SSRIs during their pregnancy, there appears to be less than a 1% chance of infants developing persistent pulmonary hypertension. This is a potentially fatal condition that is associated with use of the antidepressant in the second half of pregnancy. However, women who discontinued antidepressant therapy were five times more likely to have a depression relapse than those who continued their antidepressant. If you are pregnant, please discuss the risks and benefits of antidepressant use with your healthcare provider.
Regarding breast-feeding, caution is advised since escitalopram does pass into breast milk.
What should I discuss with my healthcare provider before taking Lexapro®?
- Symptoms that are most bothersome to you about your condition
- If you have thoughts of suicide
- Medications you have taken in the past to treat MDD or GAD
- All other medications you are currently taking and any medication allergies you have.
- Any medication side effects that you may have experienced in the past, or are currently experiencing
- If you are pregnant, plan to become pregnant, or are breast-feeding
- If you drink alcohol or use illegal drugs
- Any medical problems you have.
How should I take Lexapro®?
- Escitalopram is usually taken once a day, and may be taken with or without food. Your healthcare provider will determine the dose that is right for you based upon your response.
- Use a pillbox or calendar to help you remember to take your medication.
What happens if I miss a dose of Lexapro®?
If you miss a dose of escitalopram, take it as soon as you remember to. But only if it is not too close to when your next dose is due. If it is close to your next dose, wait until then to take the medication and skip the missed dose. Do not double your next dose or take more than your prescribed dose. Discussing this scenario with your healthcare provider ahead of time is advised.
What should I avoid while taking Lexapro®?
- In some patients, escitalopram may cause dizziness or drowsiness. Make sure you know how you react to this medication before you drive, operate machinery, or do other activities that may be dangerous if you are not alert.
- Avoid drinking alcohol or using illegal drugs while you are taking escitalopram.
- Avoid skipping or missing doses of this medication. Escitalopram is meant to be taken on a daily basis in order to get your symptoms under control. Once symptoms are controlled, escitalopram should still be taken on a daily basis for the best long-term results in treating treating symptoms and preventing relapse.
What happens if I overdose with Lexapro®?
- If an overdose occurs, whether intentional or accidental, immediate medical attention is necessary. Call your doctor or emergency medical service (911).
- Symptoms that may occur in an overdose: seizures, coma, dizziness, low blood pressure, insomnia, nausea, vomiting, rapid heart rate, drowsiness, and changes in heart rhythm. In rare instances, death has occurred.
What are the possible side effects of Lexapro®?
Common side effects of escitalopram include: dry mouth, increased sweating, dizziness, nausea, diarrhea or constipation, feeling tired, insomnia, and sexual side effects. For women, sexual side effects include being unable to experience an orgasm. For men, sexual side effects include not being unable to gain or maintain an erection (impotence), delayed ejaculation, or anorgasmia. If you are experiencing a decreased interest in having sexual activity, then this may be more likely to be an untreated symptom of your Major Depression.
Rare, but serious, side effects of escitalopram include: bleeding, decreased sodium levels in the blood (risk for seizures), “switching” from depression to mania, and seizures. As stated above, people being treated for MDD are at risk for suicidal thinking—careful attention is needed for patients who are either starting antidepressants, or who are having the dose of their antidepressant increased.
Another rare, but serious side effect of SSRIs is the Serotonin Syndrome. When this occurs, people experience several of the following symptoms at the same time: inner restlessness, tremor (shaking), confusion, muscle spasms/jerking, muscle stiffness, and increased body temperature. Serotonin syndrome in rare cases is life threatening.
Talk with your healthcare provider if you experience any side effects that are bothersome to you.
Are there any risks for taking Lexapro® for long periods of time?
There are no known risks for taking escitalopram for long periods of time.
What other drugs may interact with Lexapro®?
Escitalopram may increase the medication levels of several other medications by slowing down their breakdown and elimination from the body. Examples of these medications include the following:
Tricyclic antidepressants (older)– Elavil (amitriptyline), Pamelor (nortriptyline), Tofranil (imipramine), Norpramin (desipramine), Anafranil (clomipramine)
Newer antidepressants– Cymbalta (duloxetine), Prozac (fluoxetine), Paxil (paroxetine), Effexor (venlafaxine)
Typical (older)– Thorazine (chlorpromazine), Mellaril (thioridazine), Trilafon (perphenazine), Haldol (haloperidol)
Atypical (newer)– Abilify (aripiprazole), Risperdal (risperidone)
Emsam, Eldepryl (selegeline)
Some medications, such as Prozac (fluoxetine) and Luvox (fluvoxamine) may increase the blood levels of escitalopram. It is possible that patients taking escitalopram with either of these agents may experience a change in side effects. Tell your doctor if you begin or stop taking fluoxetine or fluvoxamine therapy. Biaxin (clarithromycin), erythromycin, Cardizem (diltiazem), Nizoral (ketoconazole), Calan (verapamil), Accolate (zafirlukast) may also increase blood levels of escitalopram.
Studies have shown that Tegretol (carbamazepine; an anticonvulsant commonly used as a mood stabilizer to treat bipolar disorder) can decrease the amount of escitalopramin the blood. Medications with similar effects to carbamazepine include: Sustiva (efavirenz), Fulvicin (griseofulvin), Mysoline (primidone), Dilantin (phenytoin), Rezulin (troglitazone).
Escitalopram should not be taken with monoamine oxidase inhibitors (MAOIs) since symptoms of the serotonin syndrome have occurred.
Escitalopram may also interact with Orap (pimozide) which can cause abnormal heart rhythms—while this is rare, these abnormal heart rhythms can result in death.
Escitalopram may also interact with Imitrex (sumatriptan) possibly causing symptoms of the serotonin syndrome—while this is rare, the serotonin syndrome can result in death. This interaction may also occur with other “triptans” that work in a similar way to Imitrex.
How long does it take for Lexapro® to work?
Several weeks are often required for escitalopram to reach its maximum effectiveness; however, improvement in some symptoms may occur sooner.