Escitalopram is a popular and versatile drug that is used to treat many mental health conditions including depression, anxiety, and PTSD. However, there are some negative side effects associated with it. Read on to find out how it works, how it can help you, and what you should look out for.
Disclaimer: By writing this post, we are not recommending this drug. Some of our readers who were already taking the drug requested that we commission a post on it, and we are simply providing information that is available in the clinical and scientific literature. Please discuss your medications with your doctor.
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 and general anxiety disorder. It can also be used (off-label) for other disorders such as premenstrual syndrome (PMS), bipolar disorder, and some eating disorders [1, 2, 3, 4].
Escitalopram is marketed under the brand names Lexapro, Cipralex, Seroplex, Sipralexa, and Morcet.
Escitalopram vs. Citalopram
Escitalopram is often compared to citalopram, a closely-related SSRI and 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 thought 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 .
Escitalopram Mechanism of Action
Neurons “talk” to each other by sending chemical messengers (neurotransmitters) to one another. One of the major neurotransmitters is serotonin, which plays a significant role in mood. Lower levels of serotonin are associated with worsened mood and increased hostility .
Escitalopram, along with other selective serotonin reuptake inhibitors, 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 brain activity .
However, escitalopram is different from other selective serotonin reuptake inhibitors because it binds to the transporters at several different places (orthosteric and allosteric sites), instead of just one. This might be why escitalopram is often reported to be more effective than other antidepressant drugs [13, 14].
Uses of Escitalopram
1) Helps Treat Depression
It is also effective in treating depression in different circumstances.
Escitalopram can also help people who are grieving. Thirty adults who suffered depression after the loss of a close family member had a significant reduction of depressive symptoms after 12 weeks, with about half recovering fully .
In another study, 116 adults with unipolar non-psychotic major depression benefitted from lower levels of anxiety and pessimism, as well as improvements in concentration and sleep .
Escitalopram may even be helpful in preventing depression before it starts. Seventy-four non-depressed patients who were undergoing treatment for cancer were 50% less likely to develop depression when taking escitalopram (double-blind randomized controlled trial) .
Depression is an illness that can come and go in cycles. A study (double-blind randomized controlled trial) with 139 patients showed that people with recurrent depression who received continuing treatment with escitalopram had a significantly lower chance of relapse compared to patients who received a placebo .
Escitalopram was also able to improve symptoms of depression for 12 people suffering from both depression and alcohol abuse at the same time (DB-RCT) .
Escitalopram vs. Other Selective Serotonin Reuptake Inhibitors (SSRIs)
Combined data from 3 clinical trials demonstrated that it is significantly better at reducing depressive symptoms than citalopram. These differences in effectiveness are seen as early as 1 week into treatment .
A meta-analysis including almost 2,700 patients showed that it treated depressive symptoms more effectively than citalopram, fluoxetine, paroxetine, or sertraline .
2) Helps Treat Anxiety
Helps Treat Generalized Anxiety Disorder
In a study (double-blind randomized controlled trial) with 307 patients, escitalopram led to significant improvements in anxiety symptoms as early as 1 week into treatment. These improvements remained over the course of the 8-week study .
Pooled data from multiple studies (double-blind randomized controlled trial) with about 850 patients showed that escitalopram was effective at treating generalized anxiety disorder .
For 177 adults aged 60 and over, escitalopram significantly reduced anxiety symptoms compared to a placebo (double-blind randomized controlled trial) .
Helps Treat Social Anxiety Disorder
A meta-analysis showed that escitalopram was significantly more effective at treating social anxiety disorder compared to placebo .
A study combining 2 trials showed that escitalopram was effective at treating social anxiety disorder for young and old, male and female patients, and patients with both low and high anxiety levels. It was also effective whether patients displayed depressive symptoms or not .
Escitalopram was effective and safe for long-term (1 year) treatment of social anxiety disorder in 158 patients .
For 48 patients, a combination of escitalopram and internet-delivered cognitive behavioral therapy lowered social anxiety symptoms and public speaking anxiety more than just therapy alone (double-blind randomized controlled trial) .
In 31 social anxiety disorder patients with a fear of blushing in front of others (erythrophobia), there was a significantly lower fear of blushing symptoms after just 4 weeks of treatment .
Helps Treat Other Cases of Anxiety
One study (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 .
Escitalopram was able to significantly reduce both depression and anxiety symptoms in 200 patients over a 24-week period .
A similar study with over 2,700 patients confirmed that escitalopram was effective in both depression and anxiety treatment .
3) Helps Treat PTSD
After 3 months of use, 45 PTSD patients experienced significant improvements in their symptoms, with these improvements lasting up to 6 months .
A different study indicated 16 males with chronic PTSD had their symptoms significantly reduced. Patients with lower levels of brain-derived neurotrophic factor (BDNF) showed the greatest improvements, although escitalopram did not cause BDNF levels to increase or decrease .
In one study (double-blind randomized controlled trial) with 353 patients who had recently experienced trauma, escitalopram did not significantly reduce their chances of developing PTSD later on. However, it was able to improve sleep quality, which may partly help reduce the severity of PTSD .
4) Helps Treat Panic Disorder
A 10-week study (double-blind randomized controlled trial) with 366 patients showed that escitalopram decreased the rate of panic attacks and other panic disorder symptoms compared to placebo .
For 20 elderly patients who suffer from panic attacks, escitalopram reduced the rate of panic attacks, as well as depression and anxiety symptoms. This improvement was seen as early as 2 weeks into treatment, compared to 4 weeks for citalopram .
An open-label study in 119 panic disorder patients found significant reductions in symptom severity and functional disability after 4 to 12 weeks of treatment, with 73% of the patients being completely cured .
Fifteen female patients with panic disorder experienced an improvement in their sleep quality .
5) Helps Treat OCD
Escitalopram reduced OCD symptoms in 466 adult patients, with improvements happening as early as 6 weeks into treatment (double-blind randomized controlled trial) .
A study (double-blind randomized controlled trial) with 100 patients showed that escitalopram was able to decrease symptoms of OCD .
A small study showed that 6 out of 11 OCD patients had a significant reduction (over 40%) of OCD symptoms .
For 64 patients suffering from severe OCD, escitalopram was found to be both effective and safe at high doses .
Escitalopram can also protect OCD patients from relapsing. One study (double-blind randomized controlled trial) with 320 patients showed that those taking escitalopram were almost 3 times less likely to relapse compared to those given a placebo .
In 6 elderly adults suffering from obsessive-compulsive-related musical hallucinations, there were improvements in their hallucination symptoms .
Fifteen patients with both schizophrenia and OCD had significant improvements in their OCD symptoms over 12 weeks. Additionally, depression, tension, and anxiety levels also decreased .
6) Can Treat Eating Disorders
Escitalopram reduced the weight and severity of illness in 44 obese patients with binge-eating disorder (double-blind randomized controlled trial) .
Over a 12-week period, 31 patients with night eating syndrome had significant symptom improvement (such as lower daily calorie intake and fewer night eating incidents) .
7) Helps Treat Seasonal Affective Disorder
For 17 depressed patients, escitalopram significantly improved seasonal affective disorder symptoms .
8) Helps Treat PMS
A study (double-blind randomized controlled trial) of 151 women with premenstrual dysphoric disorder showed that escitalopram greatly reduced symptoms such as emotional instability, depressed mood, and feelings of tension .
In another report, 27 women started escitalopram either at the last stage of their menstrual cycle (luteal phase) or after symptoms appeared. In both cases, premenstrual dysphoric disorder symptoms improved .
Quality of life was improved for women with the premenstrual dysphoric disorder .
9) Helps Treat Bipolar Disorder
A study (double-blind randomized controlled trial) of 10 bipolar disorder patients showed that escitalopram reduced the number of days of mania and depression, lowered depression intensity, and improved their overall functioning .
One study looked at patients with different disorders, including bipolar disorder. Escitalopram was found to be safe and well-tolerated when used by itself or in combination with other medication (such as antipsychotics and mood-stabilizing drugs) .
10) Helps Treat Premature Ejaculation
In a study (double-blind randomized controlled trial) with 276 men, 12 weeks of treatment helped them last about 5 times longer in bed. Six months after stopping treatment, they were still able to last around 3 times as long .
One group of 37 men had their ejaculation times significantly delayed, with no decrease in libido or orgasm intensity .
Twenty-five lifelong premature ejaculation patients experienced delayed ejaculation, but they also developed less mobile sperm, a lower sperm count, and a change in sperm shape (morphology) .
11) May Improve Sleep
Escitalopram improved sleep quality and reduced insomnia symptoms in 205 healthy menopausal women (double-blind randomized controlled trial) .
For 27 patients with depression, they were better able to remember their dreams and even reported having more emotionally positive dreams after using escitalopram for 8 weeks .
Pooled data from 3 separate studies demonstrate that it reduced sleep disturbances in depressed patients .
A large review of 22 studies (randomized controlled trials) showed that escitalopram helped treat sleep problems for patients suffering from either depression or generalized anxiety disorder .
12) Alcohol Problems
Escitalopram reduced alcohol cravings as well as the amount of alcohol consumed by 40 patients with both depression and alcohol dependence .
It might also be helpful in cases of alcohol use disorder when combined with other drugs.
In a study (double-blind randomized controlled trial) of 23 adults, escitalopram combined with acamprosate (a drug used to treat alcohol dependence) significantly decreased the number of drinks per week for patients with both depression and alcohol use disorder .
In mice, escitalopram and acamprosate lowered alcohol intake in both healthy and stressed subjects .
Side Effects of Escitalopram
However, there are side effects to consider.
Three different reports have described 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 [85, 86, 87].
A study with 43 healthy male volunteers demonstrated that escitalopram actually increased fears of public speaking – the opposite of its effects in anxiety disorder patients (double-blind randomized controlled trial) .
A 56-year old depressed male experienced mania .
There has been a report of a 45-year old woman experiencing hypnic jerks (muscle twitches or spasms that occur while falling asleep) .
Restless legs syndrome was reportedly induced in a 34-year-old woman with no prior history of the syndrome .
There have been 2 instances reported where escitalopram use was associated with grinding teeth during sleep (bruxism) .
Over 10% of PTSD patients experienced diarrhea and drowsiness .
Other possible side effects can include :
- Allergic reactions
- Muscle spasms
- Eye pain
- Thoughts of self-harm
- Dry mouth
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.
Almost 15% of anxiety patients experienced ejaculation disorder, and about 5% experienced reduced libido or anorgasmia (inability to reach orgasm) .
Sexual dysfunction (lower sexual pleasure, desire, orgasm frequency, etc.) rates were significantly higher for depressed patients taking escitalopram compared to a placebo. However, sexual functioning improved for patients who were no longer depressed .
Reduced libido was reported as a side effect in a study with premenstrual dysphoric disorder patients .
In rats, chronic use leads to erectile dysfunction (potentially by lowering nitric oxide bioavailability) .
When 14 out of 25 patients suddenly stopped using escitalopram (for depression), they developed antidepressant discontinuation syndrome. Symptoms include :
- Muscle tension
- Difficulty concentrating
- Memory loss/amnesia
- Emotional instability/mood swings
Abruptly stopping the drug also led to mania in a woman undergoing treatment for unipolar depression .
One man with panic disorder reported having “brain zaps” (sensations of electric shock inside the head) after he suddenly stopped taking escitalopram .
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 of Escitalopram
They include :
- Known hypersensitivity to escitalopram or any of its components.
- Escitalopram should not be given with or within 14 days after stopping a monoamine oxidase inhibitors (MAOIs), including linezolid and methylene blue, due to an increased risk of serotonin syndrome.
- Escitalopram should not be used with the drug pimozide (an anti-psychotic).
Escitalopram Use During Pregnancy and Breastfeeding
Escitalopram and citalopram have not been shown to be unsafe to take during pregnancy or while breastfeeding. Larger studies are needed to completely rule out any detrimental effects the two drugs may have, but several smaller studies have not found any negative effects of escitalopram in regard to pregnancy outcomes [105, 106].
Drug Interactions of Escitalopram
Because monoamine oxidase inhibitors (MAOI) and escitalopram both increase serotonin in the brain, they should not be combined. One report shows that combining escitalopram and rasagiline can cause serotonin syndrome .
Another case of serotonin syndrome was reported when it was used together with dextromethorphan (a common medication used to treat coughs and colds) .
A case of escitalopram combined with lithium led to restless leg syndrome for a 46-year-old man with bipolar disorder .
The combination of escitalopram and clonidine led to severe drowsiness in an already very ill patient .
After taking risperidone in addition to escitalopram, one young adult developed Parkinson’s disease-like symptoms including tremors, rigidity, slower cognitive function, and bradykinesia .
Other potential drug interactions include :
- Amphetamines (such as Adderall)
- Blood Thinners
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Triptan medicine
Forms and Dosage of Escitalopram
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, data pooled from 3 trials showed that 10 mg per day was optimal for moderate cases, while 20 mg per day was needed for more severe cases .
One study showed that doses up to 35 mg per day were safe in 60 depressed patients .
For OCD patients, high doses up to 40 mg per day were safe and effective for most patients, although lower doses at 20 mg per day are more standard .
For patients with social anxiety disorder, 5 to 20 mg per day is an effective and tolerable dosage .
Escitalopram is absorbed by your body the same regardless of your food intake, so dosage levels do not have to be altered based on a particular diet .
While it is possible to overdose on escitalopram, such overdoses are generally not fatal.
A review of 79 overdose cases revealed no deaths. However, overdoses did lead to a number of adverse effects including serotonin toxicity, erratic heartbeats (QT prolongation), and slowed heart rate (bradycardia) .
Other common effects of overdose are tachycardia (elevated heart rate), sudden and extreme drowsiness, elevated blood pressure (hypertension), and vomiting .
Limitations and Caveats
While most studies point to escitalopram being more effective than citalopram for depression treatment, one meta-analysis study disputes this .
One study found that for depression treatment, escitalopram was not any better compared to sertraline (Zoloft) .
A study comparing the effectiveness of escitalopram versus placebo for night-eating syndrome found no significant differences between the two .
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 researchers conducting the experiment know which patients are getting what drugs, and there are no placebos for reference. These types of studies are therefore prone to bias.
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 many different variables at play that can lead to a particular result. Clinical studies usually provide more relevant information than case reports or anecdotal accounts.
Genetics Related to Escitalopram
Escitalopram is processed and broken down (metabolized) differently by people, due to genetic differences. The enzyme that breaks it down (CYP2C19) can be grouped into 3 versions: a poor version, an intermediate version, and a good (extensive) version .
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 version .