Escitalopram (Lexapro)

What is escitalopram?

Escitalopram is known as Lexapro in the United States and Japan (レクサプロ on Japanese packaging), and Cipralex in the UK and much of Europe; it's all the same medicine. It belongs to the SSRI group of antidepressants. It works on serotonin, a chemical messenger in the brain linked to mood and anxiety. It's one of the most widely used antidepressants, often chosen first because it tends to be well tolerated.

How is it different from other antidepressants?

In large published comparisons of antidepressants, escitalopram consistently ranks as one of the best balanced between effectiveness and tolerability. In practice, that balance looks like this:

• Works on both low mood and anxiety, which often travel together
• Simple dosing: once a day, and the starting dose is already an effective dose
• Fewer interactions with other medicines than several other SSRIs
• Gentler to come off than some antidepressants in its group

What is it used for in Japan?

• Depression
• Social anxiety disorder

How does it help?

By gradually increasing serotonin in the brain, it eases low mood and anxiety over time. The full effect often takes a few weeks. If you don't feel better right away, that's normal; keep taking it as prescribed.

What should I tell my doctor before starting?

Escitalopram suits most people, but a few situations rule it out entirely; your doctor will choose something else if any of these apply:

• A past allergic reaction to escitalopram
• Taking, or recently stopping, an MAO inhibitor (a medicine for depression or Parkinson's); these can't overlap
• The medicine pimozide; the combination isn't allowed
• A known prolonged QT interval (including congenital long QT syndrome)

And tell your doctor first if any of these apply; these usually just need adjustments or a closer eye:

• Any other heart rhythm concern, heart disease, or a family history of sudden cardiac problems
• Other antidepressants, tramadol (a painkiller), or migraine triptans
• Serious liver problems
• Blood thinners, or regular painkillers like ibuprofen
• A history of seizures
• Being older, or taking water tablets (diuretics)
• Pregnant, planning to be, or breastfeeding (see the section below)

Your doctor may check your heart rhythm with an ECG if you have any heart concerns, as escitalopram can affect it a little, more so at higher doses.

How do I take it, and what if I miss a dose?

Escitalopram is taken once a day; in Japan it's usually prescribed after the evening meal, and the timing can be adjusted with your doctor (to bedtime, for example) if that's easier to remember or if it makes you sleepy.

• If you miss a dose: take it when you remember, unless the next dose is close; in that case just skip. Never take a double dose to catch up
• The first week or two is when stomach symptoms and restlessness are most likely; they usually fade as your body adjusts
• Rarely, the early weeks bring the opposite of calm: unusual agitation, irritability, or feeling wired. If that happens, contact your doctor promptly rather than waiting it out

What side effects should I expect?

Most are mild and settle within the first week or two as your body adjusts, and many can be eased with a counter-medicine (for nausea, for example). Not everyone gets them; the rough figures below just give a sense of how common each one is.

• Drowsiness (around 20%), or trouble sleeping (less common); mostly early on
• Nausea (around 20%): taking it with food helps, and it usually fades within the first weeks
• Headache
• Dizziness
• Dry mouth
• Feeling a bit more anxious or restless at first; this usually passes as the medicine starts working
• Sexual side effects

If anything is bothering you, tell your doctor; there's often a way to adjust. And if you ever feel worse instead of better, tell us straight away; it's easily managed, and that's what we're here for.

Will I become dependent? How do I stop safely?

No; escitalopram isn't addictive, but it does need a planned, gradual stop. There's no craving and no urge to take more the way some sleep or anti-anxiety medications cause. Your body does get used to it, though, and stopping suddenly can cause withdrawal-like symptoms: dizziness, tingling, brief electric-shock-like sensations, irritability, poor sleep, or vivid dreams, usually starting a few days after stopping and settling over days to a couple of weeks. So never stop suddenly on your own.

Tapering makes this a non-issue for most people: the dose comes down in small steps (often halving at a time), staying a week or two at each step, with a gentler pace near the end. If symptoms do appear along the way, stepping back up briefly and slowing down solves it. Among antidepressants, escitalopram is one of the gentler ones to come off. Many people continue for some months after they feel better, and coming off is planned together.

Can I drive while taking it?

Yes, with care, especially at the start. Escitalopram can cause drowsiness or dizziness, so see how it affects you before driving, particularly when starting or changing the dose. The Japanese label asks for caution here, not a ban.

What about pregnancy and breastfeeding?

Often, treatment can continue through both. Neither pregnancy nor breastfeeding is an automatic reason to stop; the decision is made individually with your doctor, weighing the real risks of untreated depression. Never stop on your own on learning you're pregnant. In practice, escitalopram is among the options that can be continued when needed, and breastfeeding is often possible too. Our guides to medication in pregnancy and medication while breastfeeding cover the details.