What is Lexapro?

Lexapro box and pills

Escitalopram, sold under the brand name Lexapro, is an antidepressant used to treat major depressive disorder (MDD) in adults and pediatric patients 12 years of age and older. Also, it is used to treat generalized anxiety disorder (GAD) in adults and pediatric patients 7 years and older. The use of Lexapro to treat generalized anxiety disorder for children 7 years and older was only recently approved by the Food and Drug Administration (FDA). The drug is not approved for use in pediatric patients less than 7 years of age.

How does Lexapro work?

Lexapro is a selective serotonin reuptake inhibitor (SSRI) which works by binding and inactivating the sodium-dependent serotonin transporter protein (SERT) in the presynaptic neuron of the brain. Inactivation of SERT causes an increase in synaptic serotonin levels. An increase in serotonin levels subsequently improves moode and alleviates symptoms of depression or anxiety. 

What to do before taking Lexapro

Before taking Lexapro, inform your doctor of any known medical condition(s) you had experienced in the past or currently suffering from. This includes drug addiction, suicidal thoughts, or sexual problems.  Patients with illnesses or disorders that cause changes in their metabolism or hemodynamic response should receive extra attention.

Also, make sure your physician is aware of any additional medications you use. This includes herbal remedies, opioids, stimulants, or drugs used for depression, mental illness, Parkinson’s disease, migraine headaches, major infections, and nausea and vomiting prevention. These medications have the potential to interact with Lexapro and result in serotonin syndrome, a dangerous illness.

When to avoid Lexapro

Lexapro should not be used together with pimozide or citalopram (Celexa). Also, it should not be taken within 14 days before or 14 days after using a monoamine oxidase (MAO) inhibitor. MAO inhibitors include isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, or tranylcypromine. Finally, patients with known sensitivity or allergy to escitalopram or citalopram or any of the inactive ingredients in Lexapro should not take the drug.

Administration and dosage

The recommended dosage of Lexapro for treating both depression and anxiety in both adults and young children 7 years or older is 10 mg once daily. However, a maximum dosage of 20 mg can be administered daily as determined by your doctor. Lexapro is administered orally and once daily, in the morning or evening, with or without food. The best time to take Lexapro (morning or evening) will depend on the patient’s preference. If Lexapro stops you from getting to sleep, then take it in the morning. However, if it makes you feel sleepy, then take it at night. On the other hand, individuals who experience night sweats with Lexapro can take it in the morning. This is because sweating during the day is more manageable.

For first time episode of depression or anxiety, your doctor may prescribe Lexapro for a set period, usually 6 to 12 months. Patients with persistent depression may however take it for many years. There are no known problems when the drug is taken long-term.

Take Lexapro at the same time every day. If you do miss a dosage, however, take the medication as soon as you remember. But, if your next dose is practically due, skip the missing dose. Avoid taking two doses at once. If you overdose, contact a poison help line, or get emergency medical assistance.

Never start taking Lexapro without a doctor’s advice. Once you begin taking Lexapro, be careful to visit your doctor for routine checkups. Inform your friends, family, and caregivers of any changes in your symptoms or mood. This is because while starting antidepressant medication, some young people experience suicidal thoughts or actions. 

How long does it take for Lexapro to start working?

Lexapro works by slowly increasing the level of serotonin in the brain and requires time for the body to adjust. Consequently, it takes about 4 to 6 weeks for Lexapro to start working and provide symptom relief from depression or anxiety. But for some people, it can take as little as 1 to 2 weeks to start noticing the benefits of the drug. An increase in energy, appetite, or sleep quality are indicators that Lexapro is beginning to work. If the medication is not helping, continue taking it as prescribed and let your doctor know.

How long does Lexapro stay in your system?

It takes about 5 hours for Lexapro blood concentration to reach its peak after taking the medication. However, Lexapro stays in your system for about 6 days, after which 99% of the drug will have left your body. This duration is because of the long half-half of escitalopram, which is between 27 to 32 hours. The exact half-life of escitalopram depends on factors such as body weight and composition, dosage, frequency of use, and rate of metabolism.

What to avoid when taking Lexapro

Except on the advice of your doctor do not take nonsteroidal anti-inflammatory drug (NSAID) when on Lexapro. This includes NSAID such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib (Celebrex), diclofenac, indomethacin, meloxicam, and others. Using an NSAID may cause you to bruise or bleed easily. Also avoid antiplatelet and anticoagulants. But if you must, then use with caution.

Do not drive or engage in risky activities until you understand how the drug affects you. Lexapro can compromise your ability to react quickly, think clearly, make decisions, or cause sleepiness.

Alcohol normally causes anxiety and depression and should not be used while taking Lexapro. Mixing alcohol with Lexapro can cause you to become more depressed, or anxious. It can also lead to dangerous side effects such as drowsiness, liver damage, or increase suicidal thoughts. On this link, patients discuss their experience on taking Lexapro and alcohol on Reddit. 

Avoid grapefruit and grapefruit juice while taking Lexapro. This can cause Escitalopram to build up in the blood resulting to dangerous side effects.
No known interactions or side effects have been found between caffeine and Lexapro.

Does Lexapro stops working over time?

Lexapro like most antidepressants can lose its effectiveness over time when overused. This can happen after more than six months of using the drug. As a result, the symptoms of depression or anxiety returns. About 33% of individuals taking antidepressants experience a return in symptoms. Factors that can cause Lexapro to stop working include drug or alcohol abuse, aging, development of additional stressful situations, health related issues, intolerance towards the drug, or pregnancy. However, in some cases the cause is unknown.

If you noticed that Lexapro is not working, keeping taking the drug until you see your doctor for advice. Do not stop abruptly. Whenthe drug loses effectiveness, the issue is frequently resolved by changing the antidepressant or altering the dosage.

Pregnancy and breastfeeding

You must inform your doctor if you are pregnant whether before or after you start taking Lexapro. Using an SSRI antidepressant such as Lexapro in the latter stages of pregnancy increases the baby’s risk of developing chronic pulmonary hypertension and poor adaption symptoms, such as feeding issues, respiratory distress, temperature instability, tremor, and irritability. However, if you fall pregnant while taking Lexapro, do not stop taking it without your doctor’s advice. If you suddenly stop taking your antidepressant, you can experience a recurrence in depression.

Lexapro rarely have any negative effects on breastfed infants, especially those who are older than two months. Also, neither Lexapro nor its metabolites affect milk production in breastfeeding mothers. However, there are reports of escitalopram and desmethylescitalopram being detected in human milk. Exposure of the infant to escitalopram or its metabolite in breast milk may lead to excessive sedation, restlessness, agitation, poor feeding, and poor weight gain. Most women taking Lexapro during and after delivery may find it difficult to nurse their babies and may need extra assistance. Consequently, breastfeeding mothers need to monitor their babies for signs of drowsiness, reduced appetite, inadequate weight gain, or anxiety.

Side effects and risks

The most often reported side effects of Lexapro include insomnia, ejaculation disorders (especially ejaculatory delay), nausea, increased sweating, fatigue, and somnolence, decreased libido, anorgasmia, and weight gain. In addition, there is increased risk of suicide thoughts and behaviors in young adults and pediatric antidepressant patients. Keep a close eye out for any clinical worsening and the onset of suicidal thoughts and actions in any patients receiving antidepressant medication such as Escitalopram.

Just like any SSRIs, Lexapro increases the risk of bleeding events. Bleeding risk increases when Lexapro is used simultaneously with nonsteroidal anti-inflammatory drugs (NSAIDs), antiplatelet agents or anticoagulants.

serotonin syndrome is another potential and life-threatening condition which emerges with the use of Lexapro. Symptoms of serotonin syndrome include seizures, agitation, hallucination, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting, or diarrhea. Inform your doctor immediately you notice these symptoms.

Other risks associated with the use of Lexapro include mania or hypomania, hyponatremia, impaired cognitive and motor performance, or angle-closure glaucoma.

Although rare, Lexapro can also cause hair loss just like most medications.

Withdrawal or discontinuation

Do not stop using Lexapro without first asking your doctor. Stopping, particularly when abruptly, can lead to severe withdrawal syndromes. Rather, the dosage ought to be gradually reduced over time, supervised by a medical professional who can assist avert or lessen any withdrawal symptoms.

Symptoms of Lexapro withdrawal may include dysphoric mood, irritability, agitation, dizziness, sensory disturbances (e.g., paresthesias such as electric shock sensations), anxiety, confusion, headache, lethargy, emotional lability, insomnia, and hypomania.

Dosage forms, strength, ingredients, and storage

Lexapro comes as a tablet or oral solution. Lexapro tablets for oral use are round, film-coated tablets that contain 6.38 mg, 12.75 mg, and 25.5 mg of escitalopram oxalate. This is comparable to 5 mg, 10 mg, and 20 mg of escitalopram base, respectively. Inactive components of the tablets include magnesium stearate, talc, croscarmellose sodium, and microcrystalline cellulose/colloidal silicon dioxide. Polyethylene glycol, titanium dioxide, and hypromellose are ingredients in the film coating.

Lexapro oral solution contains 1.29 mg/mL of escitalopram oxalate, or 1 mg/mL of escitalopram base. Sorbitol, purified water, citric acid, sodium citrate, malic acid, glycerin, propylene glycol, methylparaben, propylparaben, and natural peppermint flavor are among the other inactive components it includes. There is presently no marketing for the oral solution.

Lexapro should be stored at room temperature away from light, moisture, and children.