Escitalopram is a popular and versatile prescription medication that is used to treat depression and anxiety. Though it is considered relatively safe, there are some negative side-effects to be aware of. Read on to find out how it works and what you should know about its potential drawbacks if you’re on it.
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].
For a more in-depth look at the current medical uses of escitalopram, as well as the potential future uses currently being researched, check out this post.
Escitalopram is commonly marketed under the brand names Lexapro, Cipralex, Seroplex, Sipralexa, and Morcet.
Escitalopram vs. Citalopram
Escitalopram is often compared to citalopram, a closely-related SSRI which is actually the “parent” drug of escitalopram.
Citalopram is a mixture (racemic) containing 2 versions of the active drug, while escitalopram only has one. These 2 versions are mirror images of the same drug (“enantiomers”), just like how your right hand is the mirror image of your left hand.
It is believed that escitalopram’s version of the active molecule is better-suited for treating mental disorders – similar to how your right hand only fits properly in a right-handed glove and not in a left-handed glove [6].
In general, most reviews comparing the two have concluded that escitalopram tends to be more effective at treating depression than citalopram [7, 8, 9, 10, 11].
Mechanism of Action
Neurons “talk” to each other by sending chemical messengers (neurotransmitters) to one another. One of the most important and well-known neurotransmitters is serotonin, which is believed to play a significant role in mood. Lower levels of serotonin are associated with worsened mood and increased hostility/aggression [12].
Escitalopram, similar to other SSRI medications, essentially increases the amount of serotonin in the brain. It does this by blocking the transporters that take up serotonin back into neurons, making it so that serotonin has longer and stronger effects on general brain activity [13].
However, escitalopram is different from other selective serotonin reuptake inhibitors because it binds to serotonin transporters at several different places (“orthosteric” and “allosteric” sites), instead of just one. This property might be one of the reasons why escitalopram is often reported to be more effective than other antidepressant drugs (although more research will be needed to know for sure) [14, 15].
According to some early evidence from cell, rat, and human studies, escitalopram may also treat depression in part by promoting brain cell growth (in the hippocampus) [16, 17, 18]. However, this mechanism is still mostly speculative, and a lot more research will be needed to see how significant this effect might be, or how relevant it is to escitalopram’s effects as an antidepressant.
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 [19, 6].
Nonetheless, like any drug, escitalopram has a number of potential adverse side-effects that are important to be aware of.
Keep in mind that if you have a condition that might require you to be treated with escitalopram, the best way to minimize your risk of adverse side-effects is to make sure your doctor is fully informed about your medical history, any other drugs you are currently taking, and other relevant factors.
Three different studies have reported the development of serotonin syndrome, a condition that occurs when there is too much serotonin in the brain. In 2 of these cases, drug interactions may have been at play [20, 21, 22].
There are also 2 separate instances where hair loss (alopecia) was reported [23, 24].
A double-blind randomized controlled trial in 43 healthy male volunteers reported that escitalopram actually increased fears of public speaking – the opposite of the effects that some studies have reported in anxiety disorder patients [25].
According to one case study, a 56-year old depressed male experienced mania while taking escitalopram [26].
There has also been a report of a 45-year old woman experiencing hypnic jerks (sudden and uncontrollable muscle twitches or spasms that occur while falling asleep) on escitalopram [27].
Restless leg syndrome (RLS) was reportedly induced in one 34-year-old woman who had no prior history of the condition [28].
There have also been 2 individual case reports of restlessness (akathisia) while taking escitalopram [29, 30].
There have been 2 instances reported where escitalopram use was associated with grinding teeth (bruxism) during sleep [31].
Fatigue and sleepiness were the most commonly reported side effects for older adults with generalized anxiety disorder, according to one study [32].
One study reported that over 10% of PTSD patients experienced diarrhea and drowsiness while being treated with escitalopram [33].
Another study has reported that over 10% of depressed adolescents experienced nausea, insomnia, menstrual cramps, and headaches as a result of escitalopram treatment [34].
Other side-effects that have been reported include [35]:
- Allergic reactions
- Muscle spasms
- Hallucinations
- Confusion
- Eye pain
- Seizures
- Thoughts of self-harm or suicide
- Dry mouth
- Constipation
Escitalopram and Sexual Dysfunction
One of the unfortunate drawbacks of all selective serotonin reuptake inhibitor (SSRI) drugs is that they can often cause negative side effects for sexual function, such as a loss of libido or inability to achieve orgasm.
For example, one study claims that almost 15% of anxiety patients reported experiencing ejaculation disorder, with about 5% reported significantly reduced libido or anorgasmia (inability to reach orgasm) [36].
Sexual dysfunction (lower sexual pleasure, desire, orgasm frequency, etc.) rates were reported to be significantly higher in depressed patients taking escitalopram compared to those treated with a placebo. However, sexual functioning was reported to improve for patients who were no longer depressed [37].
Reduced libido was also reported as a side effect in another study in premenstrual dysphoric disorder patients [38].
In rats, chronic use of escitalopram sometimes leads to erectile dysfunction (potentially by lowering nitric oxide levels) [39].
Escitalopram Withdrawal
Although escitalopram is considered safe when used as directed under the supervision of medical professionals, it is possible to experience withdrawal symptoms – especially if the medication is stopped suddenly.
For this reason, doctors will usually advise their patients to gradually taper off their use of escitalopram, rather than stopping all at once. In any case, the most important factor is to always to talk to your doctor about any changes in your medication, and to follow any advice they give you as carefully and accurately as possible.
In one study, when 14 out of 25 patients suddenly stopped using escitalopram for depression, they developed antidepressant discontinuation syndrome. Its symptoms include [40]:
- Dizziness
- Muscle tension
- Chills
- Difficulty concentrating
- Memory loss / amnesia
- Emotional instability / sudden mood swings
Abruptly stopping the drug also reportedly led to mania in a woman undergoing treatment for unipolar depression [41].
According to one case study, a man with panic disorder reported experiencing “brain zaps” (sensations of electric shocks inside the head) after he suddenly stopped taking escitalopram [42].
Psychiatrists generally avoid triggering antidepressant discontinuation syndrome by slowly tapering patients off the drug, giving them prescriptions for progressively small doses over an extended period of time. For these reasons, it is important to consult a medical expert if you are thinking of stopping your antidepressant treatment.
Contraindications
Although escitalopram has a number of relatively well-supported medical uses when administered by qualified medical professionals, there are a number of factors that doctors may look for that might disqualify someone from receiving escitalopram treatment (due to elevated risk of negative side-effects or other adverse reactions).
Some of these “contraindications” include [1]:
- A history of hypersensitivity to escitalopram or any of its components.
- A history of mania or prior manic episodes
- Escitalopram should not be given with or within 14 days after stopping a monoamine oxidase inhibitor (MAOI), such as linezolid and methylene blue, due to an increased risk of serotonin syndrome.
- Escitalopram should not be used with the drug pimozide (an antipsychotic).
Escitalopram Use During Pregnancy and Breastfeeding
Escitalopram and citalopram have not been proven to be unsafe to take during pregnancy or while breastfeeding. However, keep in mind that this isn’t quite the same as being proven as safe! Larger studies will be needed to completely rule out any detrimental effects the two drugs may have – but so far, several smaller studies have not found any negative effects of escitalopram in regard to pregnancy outcomes [43, 44].
Because negative effects during pregnancy or nursing cannot be completely ruled out, the FDA generally advises caution when using escitalopram while pregnant or breastfeeding [1].
Drug Interactions
Although escitalopram is thought to have relatively few drug interactions, there are some important ones to be aware of [6, 45, 46].
As always, make sure to keep your doctor fully up-to-date about any and all medications you are currently taking, so that they can help minimize the risk of adverse interactions.
Because monoamine oxidase inhibitors (MAOI) and escitalopram both increase serotonin in the brain, they should not be combined. For example, one report concluded that combining escitalopram and the MAOI rasagiline may potentially cause serotonin syndrome [47].
Another case of serotonin syndrome was reported when it was used together with dextromethorphan (a common medication used to treat coughs and colds) [48].
A case of escitalopram combined with the mood-stabilizer lithium led to restless leg syndrome according to a case study of one 46-year-old man with bipolar disorder [49].
Additionally, another case study reported that the combination of escitalopram and clonidine led to severe drowsiness in one already very ill patient [50].
After taking risperidone in addition to escitalopram, one young adult reported developing Parkinson’s disease-like symptoms – including tremors, rigidity, slower cognitive function, and generally slowed movements (bradykinesia) [51].
Other potential drug interactions to be aware of include [52]:
- Pimozide
- Amphetamines (such as Adderall)
- Buspirone
- Carbamazepine
- Fentanyl
- Tramadol
- Blood Thinners
- Diuretics
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Triptan medicine
Overdose
Overdoses are unlikely if you are careful to take the medication exactly as directed by your doctor, who will only prescribe you a dose that is known to be safe and effective for any particular condition you may have.
Nonetheless, while it is otherwise possible to overdose on escitalopram (for example, by accident), such overdoses are generally not fatal.
For example, a review of 79 cases of escitalopram overdose reported no deaths. However, overdoses did lead to a number of adverse effects including serotonin toxicity, erratic heartbeats (QT prolongation), and slowed heart rate (bradycardia) [53].
Other common effects of escitalopram overdoses are tachycardia (elevated heart rate), sudden and extreme drowsiness, elevated blood pressure (hypertension), and vomiting [54].
Limitations and Caveats
While most studies point to escitalopram being more effective than citalopram for depression treatment, one meta-analysis study disputes this [55].
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) [56].
(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 [57]. 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.
Genetics
Escitalopram is processed and broken down (metabolized) differently by people, due in part to genetic differences.
For example, the enzyme that breaks escitalopram down (CYP2C19) can be grouped into 3 versions: a “poor” version, an “intermediate” version, and an “extensive” version [58].
A study looking at 78 Chinese patients with PTSD showed that escitalopram was able to reduce PTSD and anxiety symptoms to a greater degree for patients with the “poor” version of the enzyme, compared to the “intermediate” or “extensive” versions [58].
You can analyze your genome – including the CYP2C19 gene – with SelfDecode to find out which version (“genotype”) you have.
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Takeaway
Escitalopram is an antidepressant belonging to the class of selective serotonin reuptake inhibitors, or SSRIs. It differs from its parent drug, citalopram, in the shape of the molecule, which appears to make it significantly stronger and faster-acting. Like other SSRIs, escitalopram works by increasing the amount of available serotonin in the brain.
Escitalopram is considered relatively safe and tends to have fewer and less severe side effects than other SSRIs. However, some side effects, especially sexual dysfunction, are quite common.
Like all SSRIs, escitalopram should not be given alongside or within 14 days of stopping MAOIs or pimozide. It also has a long list of other potential drug interactions. To avoid adverse events or unexpected interactions, talk to your doctor about all of your medications and medical history before starting escitalopram.
