side effects, dosage, reviews, how to take & discontinue, uses, pros & cons, and more

> Lexapro (escitalopram) Overview


Lexapro Article Index | Brand and Generic Availability

Brand & Generic Names; Drug Class

US brand name: Lexapro
Generic name: escitalopram
Drug Class: Antidepressants
Learn More about Lexapro’s Generic & Worldwide Availability
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Lexapro’s Approved & Off-Label Uses (Indications)

US FDA Approved Treatment(s)

Major depressive disorder (MDD) in adults & adolescents. Generalized anxiety disorder (GAD) in adults.

Popular Off-Label Uses

The entire panic-anxiety spectrum, including: Social anxiety disorder (SAnD), obsessive compulsive disorder (OCD), and post traumatic stress disorder (PTSD). Also bipolar depression.

Learn More about Lexapro’s Approved & Off-label Uses

How Long Until Lexapro Starts Working (Onset of Action)

Lexapro can start working within one week. You should still give it at least three weeks. Unless the side effects hit hard and fast.

Likelihood of Working

If you’ve never taken an antidepressant before, and for all you and your doctor know serotonin is a big part of your problem, the odds are pretty damn good that Lexapro will help for MDD. Although the odds of Lexapro working may not be statistically much better than Celexa (citalopram), they both have better chances of working for MDD than all the other SSRIs, and most other antidepressants. I.e. around a 60–75% chance of response (they’ll do something positive) and 50–70% chance of remission (kiss that MDD goodbye, as long as you’re taking your meds).

The odds are similar for GAD. Learn how Lexapro Compares with Other Drugs

How to Take Lexapro

Lundbeck & Forest’s Recommendations

Per the PI sheet: 10mg once a day, for whatever your problem is. That’s it.

Crazymeds’ Suggestions

Start at 5mg a day for anything in the Anxiety or Depression spectra. Increase by 2.5 to 5mg a day after at least a week, and only if needed.

How to Stop Taking Lexapro (Discontinue, Withdrawal)

Decrease your dosage by 5mg every week. So if you’re taking 10mg a day, take 5mg for a week, then you can stop. 2.5mg a day if you really need to. If you experience severe SSRI discontinuation syndrome that’s not going away, talk to your doctor about a prescription for flouxetine or the oral solution for a slow tapering off.

Learn More about Taking and Discontinuing Lexapro

Lexapro’s Pros and Cons

Pros

Works faster than other serotonin-selective reuptake inhibitors (SSRIs). Many people who take it have reported it has better effects and lower chances for side effects than other SSRIs (especially weight gain), and when side effects do strike most of them tend to be less harsh. Fewer drug-drug interactions than any other SSRI.

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Cons

Few dosage options with the tablets. Some side effects (teeth grinding, TMJ, anorgasmia) can be way worse than with other SSRIs, and those first two can get really painful.

Interesting Stuff your Doctor Probably didn’t Tell You about Lexapro

If you want to be as much of a pedantic asshole about these things as I am, Lexapro is the only true SSRI. All the others affect something else, usually one or more other neurotransmitters, to some extent, although only enough for side effects, off-label uses, or as the reason why only one SSRI works for somebody. Unfortunately its purity of serotonin action can lead to interference with dopamine and norepinephrine, and that can cause some problems.

Best Known for

The Lexapro Yawn. It doesn’t matter that you’re not tired, you can yawn so intensely and so often that your jaw can pop out of its joints and you’ll need to see a doctor about that.
I’m sorry if reading this made you yawn, especially if you take Lexapro.

Working faster than any SSRI or SNRI.
In-Depth Pros & Cons

Lexapro’s Side Effects (Adverse Reactions)

Typical Side Effects

The usual for SSRIs - headache, nausea, dry mouth, sweating, sleepiness or insomnia (with insomnia more likely), constipation weight gain and assorted sex problems.

Weight gain is a lot less likely than with other SSRIs and all of the typical side effects tend to be milder. The most likely sexual side effect is anorgasmia, i.e. you can’t come, no matter how much romance and/or porn is involved. In the prudish language of PI sheets and clinical trials, anorgasmia affects only women. With men the problem is listed as an “ejaculation disorder.”

Uncommon Side Effects

SSRI-Induced Indifference / Apathy. Teeth grinding (bruxism). Yawning, jaw tightening and clenching to the point of temporomandibular joint syndrome (TMJ) and a dental specialist’s intervention (e.g. wearing a mouth guard at night).

Freaky Rare Side Effects

Sexsomnia (I wish I could read Dutch), labial pigmentation and lichenoid eruption, and atypical jitteriness syndrome (which reads like a Prescott Pharmaceuticals product side effect).

Learn More about Lexapro’s Side Effects.
TMI at times

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What You Really Need to be Careful About

Heart arrhythmia problems like torsades de pointes (TdP)/prolonged QT interval (QTc). This happens more often than I had originally thought, as both Celexa (citalopram) and Lexapro (escitalopram) are on the list of drugs to totally avoid if you have a history of TdP/QTc/cardiac arrhythmia.

Lexapro’s Black Box and Other Warnings, Pregnancy Category, etc.

Pharmacology

escitalopram’s Half-Life & How Long Until It Clears Your System

Plasma half-life: Half-life: 27–32 hours. Clearance: 6–8 days.

escitalopram’s Pharmacokinetics Information Overload

Half-life is the average time it takes for you to process half of the drug’s active ingredient. If a drug has a half-life of around 24 hours and you take a dose of 100mg, you’ll have roughly the equivalent a 50mg dose after one day, a 25mg dose after two days, and so on. The rule of thumb is: multiply the half-life by five and you get how long it is for the dose you took to be cleared from your bloodstream, so there’s nothing swimming around to attach itself to your brain and start doing stuff1. That’s called “plasma clearance.” Complete clearance is a complex equation based on a lot of factors which may or may not: be published in the PI sheet, include personal data like your weight, or even completely figured out by corporate and independent researchers. It usually winds up being 2–5 days after plasma clearance no matter what2, but can take weeks. Sometimes a drug will clear from your brain and other organs before it clears from your blood. If we’ve found the complete clearance, or how to calculate it if it requires things like your weight and what your piss looks like, you’ll find that on escitalopram’s pharmacokinetics page.

How escitalopram Works

the current best guess at any rate
What all SSRIs are supposed to do: increasing the transmission and levels of serotonin, inhibiting the serotonin reuptake pump, desensitizing 5-HT1A receptors, and nothing else. As far as neurotransmitters are concerned.

Learn More than You Probably Ever Wanted to Know about How escitalopram Works
AKA mechanism/method of action, pharmacodynamics

Ratings, Reviews, Comments, PI Sheet, and More

Lexapro Comments

Lexapro is probably the best-tolerated and most effective SSRI currently on the market. Mainly because it’s just a little better than Celexa (citalopram). Celexa was chosen as the first antidepressant used in the massive STAR*D study for being the best-tolerated SSRI and was considered the most effective. Lexapro was too new at the time. Is Celexa really more effective than all the other SSRIs? Yes, but not by all that much. It did rather well in the STAR*D study, with almost half the people responding, but a third of them relapsing. One thing Lexapro does well is preventing relapses.
Extended Comments
As if I didn’t go on long enough already.

Lexapro Ratings & Reviews, and Consumer Comments & Experiences

Rate Lexapro

Give your overall impression of Lexapro on a scale of 0 to 5. Detailed ratings and reviews are available on the Lexapro Ratings & Reviews Page.

Get all critical about Lexapro

4 stars Rating 3.6 out of 5 from 262 criticisms.
Vote Distribution: 24 – 11 – 14 – 27 – 90 – 96


Rate this article

If you’re still feeling judgmental as well as just mental3, please boost or destroy my self-confidence by honestly (and anonymously) rating this article on a scale of 0 to 5. The more value-judgments the better, even if you can criticize my work only once.

Get all judgmental about the Lexapro (escitalopram) Overview

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It’s always a good idea to check for drug-drug interactions yourself. Just because most people in the crazy meds business know about really important interactions (e.g. MAOIs and a lot of stuff, warfarin and everything on the planet) doesn’t mean the person who prescribed your meds told you about them, or the pharmacist has all the meds you take at their fingertips like they’re supposed to. Or they have the time to do their jobs properly when not dealing with complete idiots or playing Angry Farmers on the Faecesbooks.



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References

  1. Lexapro’s Full US Prescribing Information
  2. Faught, Edward. “Topiramate in the treatment of partial and generalized epilepsy.” Neuropsychiatric disease and treatment 3.6 (2007): 811-821.

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Lexapro Article Index | Brand and Generic Availability

1 Based on Julien's calculations from A Primer of Drug Action, the half-life multiplied by five is the generally accepted estimate of how long it takes a single dose of any given drug to be eliminated from the blood stream/plasma of someone with a normal metabolism. That's also the rough estimate for steady stage if they can't get, or won't provide a number for that.

2 For crazy meds. I have no idea what the average complete clearance is for other types of medications. For all I know there are drugs that utterly vanish from your system in under five passes, and others that won't let go of your squishy bits for years after you stop taking them.

3 Thank you! I'll be here all weak. Be sure to tip your content provider. And don't try the veal, it's cruelicious!

4 These include: Canada's Product Monographs (PM), New Zealand's Medicine Data Sheets (MDS), the EU's European Public Assessment Reports (EPAR), and the Summary of Product Characteristics (SPC) used in Britain, Ireland, and many other places.


If you have any questions not answered here, please see the Crazymeds Lexapro discussion board. We welcome criticisms of the articles, notifications of bad links, site problems, consumer experiences with medications, etc. I’m not always able to write back. Hence I never answer questions about meds via e-mail that are answered by this or other articles. Especially if they have been repeatedly asked on the forum. That’s why we write these damn things. Questions about which meds are best for your condition should also be asked on the forum; because this is a free site, so the price of admission is making things easier for somebody else searching for the same answer. We don’t deal with children on the forum or in private because after doing this for ten years I don’t have the emotional stamina to deal with kids who have brain cooties. How to contact Crazymeds. — Jerod Poore, CME, Publisher crazymeds.us


Last modified on Saturday, 28 June, 2014 at 15:34:22 by JerodPoorePage Author Date created Sunday, 05 December 2010 at 13:49
“Lexapro” by Jerod Poore is copyright © 2010 Jerod Poore Published online 2010/12/05
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Lexapro, and all other drug names on this page and used throughout the site, are a trademark of someone else.

will probably have the name of the manufacturer and trademark owner (they’re not always the same company) at or near the very bottom. Or ask Google who the owner is. The way pharmaceutical companies buy each other and swap products like Monopoly™ real estate, the ownership of the trademark may have changed without my noticing. It may of changed hands by the time you finished reading this article.




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Almost all of the material on this site is by Jerod Poore and is copyright © 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, and 2014 Jerod Poore. Except, of course, the PI sheets - those are the property of the drug companies who developed the drugs the sheets are about - and any documents that are written by other people which may be posted to this site will remain the property of the original authors. You cannot reproduce this page or any other material on this site outside of the boundaries of fair use copying without the express permission of the copyright holder. That’s usually me, so just ask first. That means if want to print out a few pages to take to your doctor, therapist, counselor, support group, non-understanding family members or something like that - then that’s OK to just do. Go for it! Please. As long as you include this copyright notice and something along the lines of following disclaimer, I’m usually cool with it.



All rights reserved. No warranty is expressed or implied in this information. Consult one or more doctors and/or pharmacists before taking, or changing how you take any neurological and/or psychiatric medication. Your mileage may vary. What happened to us won’t necessarily happen to you. If you still have questions about a medication or condition that were not answered on any of the pages you read, please ask them on Crazy Talk: the Crazymeds Forum.
The information on Crazymeds pertains to and is intended for adults. While some information about children and adolescents is occasionally presented (e.g. US FDA approvals), pediatric-specific data such as dosages, side effects, off-label applications, etc. are rarely included in the articles on drugs or discussed on the forum. If you are looking for information regarding meds for children you’ll have to go somewhere else. Plus we are big pottymouths and talk about S-E-X a lot.
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All information on this site has been obtained through our personal experience and the experiences family, friends, what people have reported on various reputable sites all over teh intergoogles, the medications’ product information / summary of product characteristic (PI/SPC) sheets, and from sources that are referenced throughout the site. As such the information presented here is not intended as a substitute for real medical advice from your real doctor, just a compliment to it. You should never, ever, replace what a real doctor tells you with something from a website on the Internet. The farthest you should ever take it is getting a second opinion from another real doctor. Educate yourself - always read the PI/SPC sheet or patient information leaflet (PIL) that comes with your medications and never ever throw them away. OK, you can throw away duplicate copies, but keep at least one, as that’s your proof of purchase of having taken a med in case a doctor doubts your medical history. Plus they take up less space than a bottle, although keeping one inside of a pill bottle is even better.
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Very little information about visitors to this site is collected or saved. From time to time I look at search terms used and which pages they bring up in an effort to make the information I present more relevant. And the country of origin, just because I’m geeky like that. That’s about it. Depending on how you feel about Schrodinger, our privacy policy should either assuage or exacerbate your paranoia.
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1 While there are plenty of books to help you with hypochondria, for some reason there’s not much in the way of websites. Then again, staying off of the Internet is a large part of curing/managing the disorder.

2 Remember kids, Microsloth operating systems are like TOS Star Trek movies with in that every other one sucks way, way more. With TOS Star Trek movies you don’t want to bother watching the odd-numbered ones. With Microsloth OS you don’t want to buy and install the even-numbered ones. Anyone who remembers ME and Vista knows what I mean.

3 Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas? I don’t even need my big-ass rant any more. Heartbleed has made my case for me. And that’s just the one that got all the media attention. The very nature of an open source operating system makes security as much of an illusion of anonymity. Before you flip out too much: the domain Crazymeds is hosted on uses a version of SSL that is not affected by the Heartbleed bug. That’s one of the many reasons why I pay a lot of money and keep this site on Lunarpages.

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