Escitalopram is a popular and versatile prescription medication that is used to treat many mental health conditions including depression, anxiety, and PTSD. It also has a number of other interesting potential uses that are still being researched. Read on to find out what doctors currently use escitalopram for and where the research is headed next.
Disclaimer: This post is not a recommendation or endorsement for escitalopram. This medication is only approved for the treatment of certain specific medical disorders, and can only be taken by prescription and with oversight from a licensed medical professional. We have written this post for informational purposes only, and our goal is solely to inform people about the science behind escitalopram’s effects, mechanisms, and current medical uses.
What Is Escitalopram?
Escitalopram is an antidepressant that belongs to the selective serotonin reuptake inhibitor (SSRI) class of drugs.
It gained FDA approval in 2002 to treat depression (in adults and adolescents) and general anxiety disorder (in adults). It can also be used “off-label” for other disorders, such as PTSD, OCD, panic disorder, and premenstrual syndrome (PMS), to name just a few [1, 2, 3, 4, 5].
Escitalopram is commonly marketed under the brand names Lexapro, Cipralex, Seroplex, Sipralexa, and Morcet.
Official Medical Uses
1) Treating Depression
Escitalopram has considerable evidence in support of its use in depression, and the FDA has officially approved it for this use in both adults and adolescents [1].
For example, several large-scale reviews have concluded that escitalopram is effective at treating major depressive disorder (MDD) [6, 7, 8].
For adolescents aged 12-17, escitalopram has been reported to significantly lower depressive symptoms (in comparison to placebo treatment) [9, 10].
Daily use of escitalopram for 8 weeks was reported to decrease depressive symptoms for 17 adults suffering from depression with “atypical” features (such as overeating, oversleeping, and social anxiety) [11, 12].
Escitalopram has also been reported to help people who are grieving. For example, thirty adults who suffered depression after the loss of a close family member reported a significant reduction of their depressive symptoms after 12 weeks, with about half of the patients recovering fully [13].
According to another study, 116 adults with unipolar non-psychotic major depression reported experiencing lower levels of anxiety and pessimism, as well as general improvements in concentration and sleep [14].
Some evidence suggests that escitalopram may even be helpful in preventing depression before it starts. For example, one double-blind randomized control trial reported that seventy-four non-depressed patients who were undergoing treatment for cancer were 50% less likely to develop depression while taking escitalopram [15].
Depression is an illness that can often come and go in cycles. According to one double-blind randomized controlled trial (DB-RCT) with 139 patients, patients with recurrent depression who received continuing treatment with escitalopram showed a significantly lower chance of relapse compared to patients who only received a placebo [16].
In another DB-RCT study, escitalopram was reported to improve symptoms of depression in 12 people suffering from both depression and alcohol abuse at the same time [17].
In addition to treating depression, multiple studies show that escitalopram is safe for long-term use (up to 8-52 weeks at a time) [18, 19, 20, 21].
Escitalopram vs. Other Selective Serotonin Reuptake Inhibitors (SSRIs)
Escitalopram has been reported to be safer than other antidepressants, including its own “parent drug”, citalopram [22, 23].
For example, combined data from 3 clinical trials provide evidence that escitalopram is significantly better at reducing depressive symptoms than citalopram. These differences in effectiveness have been reported as early as 1 week into treatment [24].
Escitalopram has also been reported to be a more effective long-term treatment for depression than paroxetine (Paxil), another common SSRI medication [25, 26, 27].
Finally, the authors of a large-scale meta-analysis including almost 2,700 patients concluded that escitalopram treats depressive symptoms more effectively than citalopram, fluoxetine, paroxetine, or sertraline [28].
2) Treating Anxiety
Escitalopram also has considerable evidence in support of its use in treating certain forms of anxiety.
Escitalopram for Generalized Anxiety Disorder
The FDA has officially approved escitalopram for treating generalized anxiety disorder (GAD) in adults [1].
According to one double-blind randomized controlled trial (DB-RCT) with 307 patients, escitalopram was reported to lead to significant improvements in anxiety symptoms as early as 1 week into treatment. These improvements appeared to remain over the course of the 8-week study [29].
An analysis that pooled data from multiple DB-RCT studies (containing about 850 patients in total) concluded that escitalopram was effective at treating generalized anxiety disorder (GAD) [30].
Another DB-RCT reported that in 177 adults aged 60 and over, escitalopram significantly reduced anxiety symptoms compared to a placebo [31].
Escitalopram for Social Anxiety Disorder
Due to strong evidence for its effectiveness in treating many types of anxiety symptoms, escitalopram is also commonly used by doctors to treat more specific forms of anxiety, such as social anxiety disorder.
However, social anxiety disorder and other particular “subtypes” of anxiety disorder are technically separate medical categories from general anxiety disorder. While the evidence for these uses is strong, it is important to note that the FDA has not officially approved escitalopram for these particular disorders. So although many doctors commonly use escitalopram to treat these conditions, these are still considered “unofficial” or “off-label” uses (for more common “off-label” uses of escitalopram, see the other sections of this post farther below) [1].
A number of studies provide evidence suggesting that escitalopram may be helpful for treating social anxiety disorder.
For example, one large-scale meta-analysis concluded that escitalopram was significantly more effective at treating social anxiety disorder compared to placebo [32].
Another study combining data from 2 clinical trials concluded that escitalopram was effective at treating social anxiety disorder for young and old, male and female patients, as well as patients with both low and high anxiety levels. It was also reported to be effective whether or not patients also showed depressive symptoms in addition to anxiety [33].
Escitalopram was reported to be both effective and safe for long-term (1 year) treatment of social anxiety disorder in a study of 158 patients [19].
In a double-blind randomized controlled trial with 48 patients, a combination of escitalopram and internet-delivered cognitive-behavioral therapy (CBT) was reported to reduce social anxiety symptoms and public speaking anxiety more than just CBT therapy alone [34].
According to a study in 31 SAD patients with a fear of blushing in front of others (erythrophobia), patients reported a significantly reduced fear of blushing symptoms after just 4 weeks of treatment [35].
Escitalopram for Other Cases of Anxiety
One double-blind randomized controlled trial showed that 24 weeks of escitalopram treatment significantly reduced anxiety levels in 217 patients suffering from anxiety and acute coronary syndrome together [36].
Escitalopram was reported to significantly reduce both depression and anxiety symptoms in 200 patients over a 24-week period [37].
A similar study with over 2,700 patients concluded that escitalopram was effective when treating patients with both depression and anxiety together [38].
According to one animal study, mice separated from their mothers who showed depression and anxiety behaviors had these behaviors decreased after treatment with escitalopram (possibly due to reduced IL-1β levels and increased IL-10 levels in the ventral hippocampus) [39].
Off-Label Medical Uses
Occasionally, doctors will prescribe medications to help treat conditions that fall outside of the official uses approved by the FDA – also known as “off-label” drug use [40]. Usually, this is done because there is actually decent evidence that the drug may help, although this evidence might not be quite strong enough to get full FDA approval (which generally has very strict requirements).
As always, however, remember that the decision to use medications in this way can only be made by a licensed medical professional.
1) Seasonal Affective Disorder
While escitalopram’s effectiveness for treating general forms of depression is already well-established (and officially approved by the FDA), there is also some evidence that it may help treat more specific forms of depression, such as seasonal affective disorder (commonly known as “SAD”).
For example, one 8-week trial in 20 patients suffering from seasonal affective disorder reported that escitalopram significantly reduced SAD symptoms after 2 weeks of use [41].
According to another study of 17 depressed patients, escitalopram significantly improved seasonal affective disorder symptoms [11].
Although more studies will be needed to confirm the exact mechanisms behind escitalopram’s effects in SAD, in theory it is likely that some common mechanisms shared between SAD and general depression – such as the involvement of the serotonin system in overall mood – are at least partially responsible [42].
2) PTSD
Several lines of evidence suggest that escitalopram may be useful when treating PTSD, which is one of the common “off-label” uses for this medication.
For example, one study reported that after 3 months of use, 45 PTSD patients experienced significant improvements in their symptoms after being treated with escitalopram, with these improvements lasting up to 6 months [43].
Additionally, two separate 12-week studies reported that escitalopram significantly reduced both PTSD and depression symptoms in military veterans [44, 45].
Another study reported that 16 males with chronic PTSD had their symptoms significantly reduced by escitalopram treatment. Patients with lower baseline levels of brain-derived neurotrophic factor (BDNF) showed the greatest improvements, although escitalopram was not reported to directly cause BDNF levels to increase or decrease [46].
One double-blind randomized controlled trial with 353 patients who had recently experienced trauma reported that escitalopram did not significantly reduce their chances of developing PTSD later on. However, it was reported to improve sleep quality, which may partly help reduce the severity of PTSD [47].
In studies of rodent models of PTSD, escitalopram has been reported to reduce depression and anxiety symptoms after major stress events [48].
3) Panic Disorder
Although somewhat similar to other anxiety-related disorders, panic disorder (PD) is considered a distinct medical category. Nonetheless, there is some evidence suggesting that escitalopram may be helpful in treating panic disorder as well.
For example, one 10-week double-blind randomized controlled trial with 366 patients reported that escitalopram significantly decreased the rate of panic attacks and other panic disorder symptoms when compared to placebo treatment [49].
In a study of 20 elderly patients who suffer from panic attacks, escitalopram was reported to reduce the rate of panic attacks, as well as depression and anxiety symptoms. This improvement was reported as early on as 2 weeks into treatment, compared to 4 weeks for citalopram [50].
An open-label (non-blind) study in 119 panic disorder patients reported significant reductions in PD symptom severity and functional disability after only 4-12 weeks of treatment, with 73% of the patients reporting being completely cured of their symptoms [51].
In another study, fifteen female patients with panic disorder reported experiencing an improvement in their sleep quality – one lifestyle factor that can have a significant influence on the severity of symptoms in psychiatric disorders [52].
4) OCD
Evidence from a range of scientific studies suggests that escitalopram may be of help in reducing or managing the symptoms of obsessive-compulsive disorder, or OCD.
For example, according to one double-blind randomized controlled trial, escitalopram was reported to reduce symptoms in 466 adult patients with OCD. The patients reported these improvements occurring as early as 6 weeks into treatment [53].
Another double-blind randomized controlled trial with 100 patients reported that escitalopram significantly decreased symptoms of OCD [54].
One relatively small study reported that 6 out of 11 OCD patients experienced a significant reduction (over 40%) in their OCD symptoms [55].
In a study on 64 patients suffering from severe OCD, escitalopram was concluded to be both effective and safe at high doses [56].
Some evidence suggests that escitalopram may protect OCD patients from relapsing after their initial symptoms have been alleviated. For example, one double-blind randomized controlled trial with 320 patients reported that patients taking escitalopram were almost 3 times less likely to relapse compared to those given a placebo [57].
According to another study in 6 elderly adults suffering from obsessive-compulsive-related musical hallucinations, the patients reported noticeable improvements in their hallucination symptoms after treatment with escitalopram [58].
Similarly, a study of fifteen patients with both schizophrenia and OCD reported significant improvements in their OCD symptoms over 12 weeks of treatment with escitalopram. Additionally, these patients also reported that their depression, tension, and anxiety levels had also been reduced by the treatment [59].
5) PDD
Although less common than some of the other “off-label” uses, doctors may occasionally use escitalopram to help alleviate or manage some of the symptoms associated with menstruation in women.
According to one double-blind randomized controlled trial of 151 women with premenstrual dysphoric disorder (PDD), escitalopram was reported to significantly reduce symptoms such as emotional instability, depressed mood, and persistent feelings of tension [60].
Similarly, according to another study, 27 women who were treated with escitalopram (starting either at the last stage of their menstrual cycle (luteal phase) or after symptoms appeared) reported significant improvements in their PDD symptoms [61].
Finally, improvements in overall quality of life while taking escitalopram have also reported by women with PDD in other studies [62].
Possible Uses Under Investigation
In addition to some of the relatively well-accepted (but still technically unofficial) “off-label” uses, escitalopram has also been studied for its potential to treat a variety of other health conditions.
However, keep in mind that the evidence supporting these potential applications is still very preliminary, and a lot more additional research will be needed before any of these applications are ever officially approved for medical use. Therefore, it is important to take all of the information below with a healthy grain of salt!
1) Bipolar Disorder
A double-blind randomized controlled trial of 10 bipolar disorder patients reported that escitalopram reduced these patients’ number of days with mania and depression, lowered their depression intensity, and improved their overall functioning [63].
Escitalopram, combined with other mood-stabilizing drugs (such as lithium and valproic acid), was reported to be an effective treatment in 20 bipolar disorder patients [3].
One study looked at patients with different psychiatric disorders, including bipolar disorder. The authors of this study concluded that escitalopram was reasonably safe and well-tolerated when used either by itself, or in combination with other medications (such as antipsychotics and mood-stabilizing drugs) [64].
2) Eating Disorders
Eating disorders are another major category of psychiatric conditions that escitalopram has shown some potential to treat, although the evidence here is a bit weaker. As a result, this use is relatively somewhat less common among medical professionals than some of escitalopram’s other “off-label” uses.
One double-blind randomized control trial in 44 obese patients with binge-eating disorder reported that escitalopram both reduced the patients’ body weight, as well as the severity of their eating disorder symptoms [5].
In another study, 31 patients with night eating syndrome reported significant improvements in their symptoms (such as lower daily calorie intake and fewer night eating episodes) over 12 weeks of treatment escitalopram [4].
3) Sleep
According to one double-blind randomized controlled trial, escitalopram was reported to improve sleep quality and reduce insomnia symptoms in 205 healthy menopausal women [65].
In a study of 27 patients with depression, the patients reported being better able to remember their dreams, and even reported having more emotionally positive dreams after using escitalopram for 8 weeks [66].
A study using pooled data from 3 separate studies concluded that escitalopram reduced sleep disturbances in depressed patients [67].
Similarly, another large-scale review of 22 studies (randomized controlled trials) concluded that escitalopram may help treat sleep problems in patients suffering from either depression or generalized anxiety disorder [68].
4) Alcohol Abuse
For example, escitalopram was reported to reduce alcohol cravings, as well as the amount of alcohol consumed, in a study of 40 patients with both depression and alcohol dependence [69].
Escitalopram might also be helpful in cases of alcohol use disorder (AUD) when combined with other drugs.
For example, according to one double-blind randomized controlled trial in 23 adults, escitalopram combined with acamprosate (a drug used to treat alcohol dependence) was reported to significantly decrease the number of drinks per week for patients with both depression and AUD [17].
Similarly, another study concluded that a combination of escitalopram, naltrexone, and gamma-hydroxybutyric acid (commonly known as GHB) was more effective than escitalopram alone in preventing alcohol relapses [70].
In mice, the combination of escitalopram and acamprosate has been reported to reduce alcohol intake in both healthy and stressed animals [71].
5) Premature Ejaculation
According to one double-blind randomized controlled trial in 276 men, 12 weeks of treatment with escitalopram was reported to help some of the men to last about 5 times longer in bed. Six months after stopping treatment, they still reported being able to last around 3 times as long, suggesting that this effect may be relatively long-lasting [72].
Similarly, another study reported that a group of 37 men had their ejaculation times significantly delayed, with no decrease in libido or orgasm intensity [73].
However, there is also some evidence that these “benefits” may come at a cost. For example, twenty-five life-long premature ejaculation patients reported delayed ejaculation times on escitalopram – but testing revealed that they also developed less mobile sperm, a lower sperm count, and a change in sperm shape (morphology) [74].
This finding suggests that some of the early reports of improvement in sexual performance may come at a cost to other factors, such as fertility – and more research will definitely be needed to form any solid conclusions about this side of escitalopram’s effects.
It should also be noted that almost all SSRIs – including escitalopram – are known to frequently cause negative sexual side-effects in many depression patients. These side-effects can include dramatically reduced libido and even an inability to achieve orgasm (anorgasmia) [75, 76]. Therefore, it is pretty unlikely that escitalopram will ever become widely used as any kind of sexual performance-enhancing medication.
Potential Side Effects
Taking escitalopram at the recommended dosage – and in full accordance with a doctor’s directions – is generally considered safe. Some studies have even reported that, compared to other SSRI medications, escitalopram may cause relatively lower rates of side effects [77, 78].
Nonetheless, like any drug, escitalopram has a number of potential adverse side-effects that are important to be aware of. To learn more about them, check out this post.
Forms and Dosage
Note: The information in this section describes typical dose information for medical applications of escitalopram: it is not a guide to non-medical use, and only your doctor has the qualifications and knowledge necessary to determine the best dose for each individual case. Always follow your prescription exactly as advised by your doctor, whatever it may be.
Escitalopram is available as 5 mg, 10 mg, and 20 mg tablets, as well as a 1 mg/mL oral solution.
For major depressive disorder, an analysis of data pooled from 3 trials concluded that 10 mg per day was optimal for moderate cases, while 20 mg per day was needed for more severe cases [79].
One study of 60 depressed patients on escitalopram reported that doses up to 35 mg per day were relatively safe and well-tolerated [80].
For OCD patients, high doses up to 40 mg per day were reported to be safe and effective for most patients, although lower doses at 20 mg per day are more typical [81].
For patients with social anxiety disorder, 5 to 20 mg per day was concluded to be an effective and tolerable dosage, according to one study [82].
Escitalopram is believed to be absorbed by the body the same regardless of food intake, so dosage levels generally do not have to be adjusted based on a person’s particular diet [83]. Nonetheless, it is still always important to inform your doctor of any relevant dietary or other lifestyle factors that may affect your overall health or course of treatment.
Limitations and Caveats
While most studies point to escitalopram being more effective than citalopram for depression treatment, one meta-analysis study disputes this [84].
This study reported that for depression treatment, escitalopram did not appear to be any better or more effective compared to other antidepressants, such as sertraline (Zoloft) [85].
(Note that this isn’t evidence that escitalopram isn’t effective – it only calls into question some of the other findings that have reported it as being superior over other common antidepressants.)
Similarly, one study comparing the effectiveness of escitalopram versus placebo for night-eating syndrome reported no significant differences between the two [86]. This result calls into question whether escitalopram might actually be useful for treating eating disorders, although more studies will be needed to settle the issue for sure.
One considerable limitation for studies involving escitalopram and related drugs is that many of them are “open-label”. This means that both the patients and the researchers conducting the experiment know which patients are getting which drugs, and that there are no placebos for reference. These types of studies are therefore prone to bias, and double-blinded, placebo-controlled trials are much better when it comes to making firm conclusions about a drug and its reported effects.
Studies on side effects and drug interactions often involve only 1 or 2 people (case reports). While they are important to consider, individual cases have any number of unique variables at play that could lead to a particular result. For this reason, clinical studies generally provide more relevant information than case reports or anecdotal accounts.
Further Reading
Takeaway
Escitalopram is an antidepressant belonging to the class of selective serotonin reuptake inhibitors, or SSRIs. It is most often prescribed for depression and generalized anxiety disorder, but it is sometimes given off-label for other types of anxiety disorders, seasonal affective disorder, PTS, panic disorder, OCD, and premenstrual dysphoric disorder (PDD).
Currently, researchers are investigating whether escitalopram might help manage other conditions, including bipolar disorder, eating disorders, insomnia and other sleep disorders, alcohol abuse, and even premature ejaculation.
Regardless of the reason for the prescription, it’s very important to follow your doctor’s instructions precisely if you are taking escitalopram.
