Medication guide

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 is widely used, and 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: they often travel together
Simple dosing: once a day, and the starting dose is already an effective dose
One of the better tolerated: in the same comparisons, it was among the antidepressants people were less likely to stop early
Less prone to stopping symptoms than paroxetine: a gradual stop is still needed

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 problem, heart disease, or low potassium
Other antidepressants, tramadol (a painkiller), or migraine triptans
Liver problems
Blood thinners, or regular painkillers like ibuprofen
Glaucoma
A history of seizures, or bipolar disorder
Past suicidal thoughts, or strong impulsivity: the label asks for closer monitoring
Being older
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, after the evening meal (that's how the Japanese label specifies it). If the evening timing doesn't suit you, talk to your doctor before changing it.

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
Early on: stomach symptoms and restlessness can appear when you start, and many of these ease as your body adjusts. Some can continue, so tell your doctor if they do
Agitation: if you notice unusual agitation, irritability, or feeling wired, contact your doctor promptly rather than waiting it out
Alcohol: avoid it while taking escitalopram; the Japanese label advises against drinking

What side effects should I expect?

Many are mild and ease 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): often noticed when you start; if it is a problem, tell your doctor, as the dose can be reviewed
Nausea (around 20%): mostly when you start, and it often eases as your body adjusts; if it bothers you, tell your doctor, as a counter-medicine can help
Headache
Dizziness
Dry mouth
Feeling more anxious or restless at first
Sexual side effects
Weight changes, up or down (less common)

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, anxiety, headache, or trouble sleeping, 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 manageable for most people: the dose comes down in small steps (often halving at a time), moving to the next step once any symptoms have settled, with a gentler pace near the end. If symptoms do appear along the way, stepping back up briefly and slowing down helps, though they may take a few days to settle. Escitalopram is less prone to stopping symptoms than paroxetine, but a gradual stop is still the rule. 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?

Treatment can continue in pregnancy when the benefit is judged to outweigh the risk; the decision is individual. Neither pregnancy nor breastfeeding is an automatic reason to stop, and the real risks of untreated depression are weighed too. 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.