Lexapro (escitalopram): uses, side effects, and what to expect

If you or your psychiatrist are considering Lexapro, you probably have questions about what it does, how it works, and what to expect. This page breaks down the basics of escitalopram, including its uses, side effects, and what a Talkiatry psychiatrist wants you to know before starting.

Key takeaways

• Lexapro (escitalopram) is a selective serotonin reuptake inhibitor (SSRI) approved to treat major depressive disorder and generalized anxiety disorder.
• Escitalopram works by slowing the reabsorption of serotonin in the brain, which helps mood and anxiety pathways function more effectively.
• Most people begin noticing improvements within 2 to 6 weeks, though full effects can take longer.
• Stopping Lexapro suddenly can cause withdrawal symptoms, so any changes to your treatment should be guided by your psychiatrist.

What is Lexapro?

Lexapro is the brand name for escitalopram, a type of antidepressant known as a selective serotonin reuptake inhibitor (SSRI). It is FDA-approved to treat major depressive disorder (depression) and generalized anxiety disorder (GAD). Lexapro is one of the most commonly prescribed SSRIs in the United States and is available in generic form as escitalopram.

What does Lexapro treat?

Lexapro is prescribed for a range of mood and anxiety conditions. Some uses are FDA-approved (on-label), while others are supported by clinical experience and research but not formally approved for this medication (off-label).

On-label uses

• Major depressive disorder (depression)
• Generalized anxiety disorder (GAD)

Off-label uses

Psychiatrists sometimes prescribe Lexapro off-label for conditions where clinical evidence supports its use, even though it is not FDA-approved for them. These can include:

• Panic disorder
• Social anxiety disorder
• Obsessive-compulsive disorder (OCD)
• Post-traumatic stress disorder (PTSD)
• Premenstrual dysphoric disorder

How does Lexapro work?

Lexapro belongs to a class of medications that help your brain hold on to more serotonin, a chemical messenger involved in regulating mood and anxiety. Think of serotonin like a signal being passed between brain cells. Normally, some of that signal gets pulled back before it finishes its job. Escitalopram slows that pullback, giving serotonin more time to do its work.

• Helps your brain keep more serotonin available. Lexapro slows the reabsorption of serotonin, a brain chemical that plays an important role in mood and anxiety.¹
• Supports clearer communication between brain cells involved in mood and stress. With more serotonin circulating, the brain's mood and anxiety pathways can send signals more effectively.¹
• Gradually reduces anxiety and improves mood stability. Over time, these changes can help ease persistent worry, emotional lows, and the physical symptoms of anxiety.¹

3 things a Talkiatry psychiatrist wants you to know about Lexapro

• It's often well tolerated. Lexapro is commonly chosen as a first treatment because it tends to cause fewer side effects than some similar medications. That said, everyone responds differently, and your psychiatrist will monitor how you're doing.
• It takes time to work. Many people start noticing benefits within 2 to 6 weeks, though it can take longer for the full effect. Your psychiatrist will check in during that window to see how you're responding and whether any adjustments are needed.
• Stopping suddenly can cause symptoms. If you ever need to stop Lexapro, your psychiatrist will advise you on how to safely taper. Quitting abruptly can lead to withdrawal effects like dizziness, nausea, and irritability.

Common side effects of Lexapro

Like most medications, escitalopram can cause side effects. Many of these are mild and may improve as your body adjusts. Common side effects can include:¹

• Nausea
• Drowsiness or fatigue
• Difficulty falling asleep or staying asleep
• Increased sweating
• Sexual side effects, including decreased sex drive or difficulty with arousal or orgasm

Talk to your psychiatrist if any of these feel persistent, severe, or get in the way of your day.

Serious side effects of Lexapro and when to seek help

Serious side effects are less common, but it is important to know what to watch for. Contact your psychiatrist or seek emergency care if you experience any of the following:¹

• New or worsening depression, suicidal thoughts or thoughts of self-harm, extreme worry, panic attacks, agitation, aggressive behavior, or severe restlessness
• Signs of a manic episode, which can occur when taking an SSRI if bipolar disorder has been misdiagnosed as depression: euphoria, increased energy, intense irritability, or unusual changes in sleep or behavior
• Signs of serotonin syndrome: fever, sweating, confusion, fast or irregular heartbeat, severe muscle stiffness or twitching, loss of coordination, nausea, vomiting, or diarrhea
• Signs of a severe allergic reaction: rash, hives, blisters, fever, joint pain, difficulty breathing or swallowing, or swelling of the face, throat, tongue, lips, or eyes
• Unusual bleeding or bruising
• Seizures, persistent headache, unsteadiness, or problems with thinking, concentration, or memory
• Sudden eye pain, nausea, vision changes (such as seeing colored rings around lights), or swelling and redness in or around the eye

Call your psychiatrist right away or seek emergency care if you experience any of these symptoms.

What to watch for when starting Lexapro

The first few weeks on escitalopram are an adjustment period. Here is what to keep in mind:¹

• Full therapeutic benefit may take several weeks to develop.² Keep taking it as prescribed even if you start feeling better before then.
• Escitalopram can cause drowsiness and may affect your judgment, thinking, or coordination. Avoid driving or operating machinery until you know how it affects you.
• Alcohol can worsen side effects. Talk to your psychiatrist about safe alcohol use while on Lexapro.
• Do not stop taking escitalopram suddenly. Abrupt discontinuation can cause withdrawal symptoms such as mood changes, irritability, nausea, dizziness, tingling in the hands or feet, anxiety, headache, sweating, and difficulty sleeping.¹

What to do if you miss a dose of Lexapro

If you miss a dose, take it as soon as you remember. If it is almost time for your next scheduled dose, skip the missed one and continue with your regular schedule. Do not take a double dose to make up for a missed one.¹

Who should talk to a psychiatrist before taking Lexapro

Some health conditions, medications, and life situations change how Lexapro is prescribed. Tell your psychiatrist if any of the following apply to you:¹

• You have a known allergy to escitalopram or any of its ingredients
• You are currently taking or have recently stopped (within the past two weeks) a monoamine oxidase inhibitor (MAOI)
• You have a history of bipolar disorder
• You have a history of heavy alcohol use or substance misuse
• You have recently had a heart attack
• You have a history of bleeding problems, seizures, glaucoma, or liver, kidney, or heart disease
• You are pregnant (especially in the last few months of pregnancy), planning to become pregnant, or breastfeeding
• You are under 24 or an older adult, as age-specific risks may apply