Lexapro (escitalopram oxalate) is a selective serotonin reuptake inhibitor (SSRI) approved by the FDA for the treatment of major depressive disorder (MDD) and generalized anxiety disorder (GAD) in adults and adolescents. As one of the most widely prescribed antidepressants globally, it offers a favorable balance of efficacy and tolerability. Its mechanism focuses on enhancing serotonin activity in the brain, which plays a key role in mood regulation. Clinical studies and extensive post-marketing experience support its use for achieving remission and improving quality of life.

Features

• Active ingredient: Escitalopram oxalate
• Drug class: Selective serotonin reuptake inhibitor (SSRI)
• Available forms: Oral tablets (5 mg, 10 mg, 20 mg) and oral solution (5 mg/5 mL)
• FDA-approved for: Major depressive disorder and generalized anxiety disorder
• Half-life: Approximately 27–32 hours
• Metabolism: Primarily hepatic, via CYP450 enzymes (CYP2C19, CYP3A4, CYP2D6)

Benefits

• Effectively reduces symptoms of depression, including low mood, loss of interest, and fatigue
• Alleviates excessive worry, tension, and physical symptoms associated with anxiety
• Generally well-tolerated with a lower risk of certain side effects compared to older antidepressants
• Supports functional improvement in daily life, work, and relationships
• Once-daily dosing supports treatment adherence
• Suitable for long-term maintenance therapy in appropriate patients

Common use

Lexapro is commonly prescribed for the management of major depressive disorder and generalized anxiety disorder. It may also be used off-label for other conditions such as panic disorder, social anxiety disorder, obsessive-compulsive disorder, and post-traumatic stress disorder, under specialist supervision. Treatment is typically initiated after a thorough psychiatric and medical evaluation.

Dosage and direction

For major depressive disorder and generalized anxiety disorder in adults, the recommended starting dose is 10 mg once daily, which may be increased to 20 mg daily after a minimum of one week, based on individual response and tolerability. For adolescents aged 12–17, the starting dose is 10 mg daily. Administration is oral, with or without food, preferably at the same time each day. Dosage adjustments are necessary in patients with hepatic impairment, and a lower starting dose (5 mg) is often recommended for elderly patients or those taking concomitant medications that inhibit CYP2C19.

Precautions

Patients should be monitored for clinical worsening, suicidality, or unusual changes in behavior, especially during the initial few months of therapy or after dosage changes. Lexapro may cause activation of mania/hypomania in patients with bipolar disorder; screening for bipolarity is advised prior to initiation. Use with caution in patients with a history of seizures. SSRI treatment can cause hyponatremia, particularly in elderly patients, those taking diuretics, or those who are volume-depleted. Discontinuation symptoms may occur upon abrupt cessation; gradual tapering is recommended.

Contraindications

Lexapro is contraindicated in patients taking monoamine oxidase inhibitors (MAOIs) or within 14 days of discontinuing MAOI treatment due to the risk of serotonin syndrome. It should not be used in patients with known hypersensitivity to escitalopram, citalopram, or any component of the formulation. Concomitant use with pimozide is also contraindicated.

Possible side effect

Common side effects include nausea, insomnia, ejaculation disorder, fatigue, drowsiness, increased sweating, and decreased libido. Most are mild to moderate and often subside with continued treatment. Less frequently, patients may experience weight changes, serotonin syndrome (agitation, hallucinations, tachycardia), abnormal bleeding, angle-closure glaucoma, or QT prolongation. Any persistent or severe side effects should be reported to a healthcare provider.

Drug interaction

Lexapro has the potential to interact with other serotonergic drugs (e.g., other SSRIs, SNRIs, triptans, tramadol), increasing the risk of serotonin syndrome. It may enhance the anticoagulant effect of warfarin and other drugs that affect coagulation. Strong inhibitors of CYP2C19 (e.g., omeprazole) or CYP2D6 may increase escitalopram plasma concentrations. Concomitant use with NSAIDs, aspirin, or other drugs that affect platelet function may elevate bleeding risk.

Missed dose

If a dose is missed, it should be taken as soon as remembered, unless it is almost time for the next scheduled dose. In that case, the missed dose should be skipped, and the regular dosing schedule resumed. Doubling up on doses is not recommended.

Overdose

Symptoms of overdose may include dizziness, sweating, nausea, vomiting, tremor, somnolence, and in rare cases, seizures, ECG changes, or coma. Serotonin syndrome is a potential serious outcome. There is no specific antidote; treatment is supportive and symptomatic. Immediate medical attention is required.

Storage

Store at room temperature (20–25°C or 68–77°F), in a tightly closed container, away from light, moisture, and heat. Keep out of reach of children and pets. Do not use beyond the expiration date printed on the packaging.

Disclaimer

This information is for educational purposes and does not replace professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider before starting, changing, or discontinuing any medication. Individual patient needs and responses may vary.

Reviews

Clinical trials and real-world evidence consistently report Lexapro as effective and manageable for many patients with depression and anxiety. Users often note improvements in mood, energy, and overall functioning within several weeks of consistent use. Some report side effects such as initial nausea or sexual dysfunction, though these often diminish over time. Overall satisfaction is high among responders, with many emphasizing the importance of medical supervision throughout treatment.