Escitalopram: 7 things you should know

Medically reviewed by Carmen Pope, BPharm. Last updated on Oct 3, 2023.

1. How it works

• Escitalopram may be used for the treatment of anxiety and depression.
• Experts are unsure exactly how escitalopram works, although historically it was believed that escitalopram’s effects were due to its ability to rebalance chemicals in the brain, such as serotonin, that were thought to be imbalanced in people with anxiety, depression, and other mood disorders. Studies confirm that escitalopram is still effective for treating mood disorders, such as depression, even though the way it works is unknown.
• The activity of escitalopram against other neurotransmitters, such as norepinephrine or dopamine, is much less potent than other antidepressants.
• Escitalopram belongs to a group of medications known as SSRIs (selective serotonin reuptake inhibitors).

2. Upsides

• Used to relieve depression and anxiety in adults.
• May also be used to treat depression in teenagers aged 12 through 17.
• Less likely to cause drowsiness than some other antidepressants.
• Has also been used off-label for other conditions such as panic disorder and post-traumatic stress disorder (PTSD).
• SSRIs are, in general, better tolerated than many other medicines used in the treatment of depression.
• May be more effective with fewer adverse effects than other SSRIs.
• Generic escitalopram is available.

3. Downsides

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

• Drowsiness or insomnia, diarrhea, headache, sexual dysfunction, and nausea. Side effects are generally mild and transient, and more common during the first two weeks of treatment.
• Dizziness, fatigue, constipation, indigestion, dry mouth, and increased sweating may also occur.
• An increased risk of suicidal thoughts, especially in young adults (similar to other antidepressants).
• A discontinuation syndrome if abruptly stopped or interrupted (symptoms include nausea, vomiting, diarrhea, headaches, dizziness, sweating, chills, tremors, vivid dreams, and insomnia); taper off dosage slowly over several weeks to months.
• May impair your judgment and affect your ability to drive or operate machinery. Avoid alcohol.
• Interaction or overdosage may cause serotonin syndrome (symptoms include mental status changes [such as agitation, hallucinations, coma, delirium]), fast heart rate, dizziness, flushing, muscle tremor or rigidity, and stomach symptoms (including nausea, vomiting, and diarrhea). Another serious syndrome called Neuroleptic Malignant Syndrome has also been reported; symptoms include high body temperature, muscle rigidity, and mental disturbances; discontinue immediately and seek urgent medical advice.
• May increase the risk of bleeding, especially if used with other drugs that also increase bleeding risk.
• May precipitate a manic episode in people with undiagnosed bipolar disorder.
• May cause a lowering of total body sodium (called hyponatremia); elderly people or people taking diuretics or already dehydrated may be more at risk.
• May not be suitable for some people including those with liver or kidney disease or glaucoma.
• The risk of interactions may be less than with other antidepressants.
• Exposure to SSRIs, such as escitalopram, particularly later in pregnancy, may increase the risk for persistent pulmonary hypertension of the newborn (PPHN). Complications, such as prolonged hospitalization, respiratory support, and tube feeding, have been reported in neonates exposed to SSRIs during the third trimester of pregnancy. Weigh up the potential benefits versus the risks of untreated depression. Escitalopram is excreted into breastmilk and there have been reports of drowsiness, decreased feeding, and weight loss reported in the breastfeeding infant. If a woman does inadvertently become pregnant while taking escitalopram register them on the National Pregnancy Registry for Antidepressants at 1-844-405-6185 or online at https://womensmentalhealth.org/clnical-and-research-programs/pregnancyregistry/antidepressants/.

Note: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. View complete list of side effects

4. Bottom Line

Escitalopram relieves depression and anxiety and may have less potential for side effects than some other antidepressants. Escitalopram may have fewer side effects than citalopram, a related drug.

5. Tips

• Take once a day in the morning or evening, with or without food. Do not increase the dosage of escitalopram without your doctor's advice.
• Escitalopram should make up one component of a total treatment plan for depression or anxiety that includes other non-drug components such as counseling, education, and social support.
• Report to your doctor any mood changes such as agitation or greatly increased energy, worsening depression, or suicidal thoughts. Also, monitor for serotonin syndrome; symptoms include agitation, hallucinations, coma, fast heart rate, dizziness, flushing, muscle tremor or rigidity, and stomach symptoms (such as nausea, vomiting, or diarrhea).
• Talk to your doctor or pharmacist before taking any other medications with escitalopram, including NSAIDs or St. John's Wort as these may interact.
• Talk with your doctor if you notice it takes longer than normal for cuts to stop bleeding. Also, discuss any persistent headaches or episodes of weakness or confusion.
• Report any changes in vision, redness, or swelling around the eye or eye pain.
• Do not stop suddenly as withdrawal symptoms may occur.
• Even though escitalopram is unlikely to cause drowsiness, be cautious driving or operating machinery until you know how this drug affects you. Alcohol may potentiate these effects.

6. Response and effectiveness

• Escitalopram is the active isomer of citalopram. Peak blood levels are reached approximately 5 hours after a dose but it may take up to a week for levels to become stabilized in the body. Improvement in depressive or anxiety symptoms may not be noticed for 1-4 weeks. Treatment should be continued as directed even after improvement.
• Escitalopram is the therapeutically active S-enantiomer of citalopram.

7. Interactions

Medicines that interact with escitalopram may either decrease its effect, affect how long it works, increase side effects, or have less of an effect when taken with escitalopram. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.

Common medications that may interact with escitalopram include:

• anti-anxiety medications such as lorazepam
• antipsychotics such as lithium and thioridazine
• aspirin and other NSAIDs, such as ibuprofen, diclofenac, and naproxen
• indigestion remedies, such as cimetidine
• migraine medications such as eletriptan, rizatriptan, or zolmitriptan
• monoamine oxidase inhibitors (MAOIs), such as isocarboxazid, phenelzine, or selegiline
• other antidepressants, such as amitriptyline and desipramine
• other SSRIs, such as citalopram or fluoxetine
• sleeping pills such as triazolam or zopiclone
• some antibiotics such as linezolid
• some antifungals such as ketoconazole
• some diabetes medications such as pioglitazone and rosiglitazone
• St John's Wort
• Tramadol
• warfarin and other anticoagulants
• other medications that may thin the blood.

Note that this list is not all-inclusive and includes only common medications that may interact with escitalopram. You should refer to the prescribing information for escitalopram for a complete list of interactions.

References

• Escitalopram. Revised 08/2023. Cardinal Health 107, LLC​. https://www.drugs.com/pro/escitalopram-tablets.html

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use escitalopram only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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