escitalopram

Adjunctive therapy

Brands: Lexapro

Last reviewed 2026-02-12

Reviewed by PsychMed Editorial Team.

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Quick answers

What is escitalopram?
Escitalopram (Lexapro) is an SSRI commonly used for major depressive disorder and generalized anxiety disorder with a favorable tolerability profile.
What is Lexapro?
Lexapro is a brand name for escitalopram.
What is Lexapro (escitalopram) used for?
Label indications include: Major depressive disorder; generalized anxiety disorder.
What drug class is Lexapro (escitalopram)?
Selective serotonin reuptake inhibitor (SSRI).
What strengths does Lexapro (escitalopram) come in?
Tablets: 5 mg, 10 mg, 20 mg; oral solution 5 mg/5 mL.

Snapshot

Class: Adjunctive therapy
Common US brands: Lexapro
Therapeutic drug monitoring not routinely recommended.
Last reviewed: 2026-02-12

Label indications

Major depressive disorder; generalized anxiety disorder.

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Clinical Highlights

Escitalopram (Lexapro) is an SSRI commonly used for major depressive disorder and generalized anxiety disorder with a favorable tolerability profile. Preferred over citalopram for lower QT risk at therapeutic doses and minimal drug interactions.

Hyponatremia and serotonin syndrome are key safety considerations; otherwise escitalopram is generally well tolerated with once-daily dosing.
Clinical response often begins within 2–4 weeks; an adequate trial is often ~6–8 weeks at a therapeutic dose unless adverse effects limit dosing.
Common barriers to adherence include GI upset, activation or somnolence, and sexual dysfunction—setting expectations early and discussing management options can support adherence.
The compare view and escitalopram evidence feed can support QT considerations, switching strategies, and augmentation options; mania-prevention planning can be coordinated via the bipolar disorder hub.
Discontinuation symptoms can occur with abrupt stopping (dizziness, “electric shock” sensations, irritability); tapering tends to be better tolerated than sudden discontinuation, especially after long-term use.
When anxiety is prominent, lower starting doses and slower titration can reduce early jitteriness; follow-up timing often matters more than the specific starting dose for most patients.
Major depressive disorder (FDA 2002)
Generalized anxiety disorder (FDA 2003)
Generic: Generic formulations available since 2012.

Dosing & Formulations

Tablets: 5 mg, 10 mg, 20 mg; oral solution 5 mg/5 mL. Typical adult start is 10 mg once daily; may increase to 20 mg/day after ≥1 week if needed and tolerated.

In anxiety-sensitive patients, some clinicians start 5 mg daily with slower titration to reduce early activation/jitteriness.
Elderly/CYP2C19 poor metabolizers: lower starting dose (often 5 mg) and lower max (10 mg/day) are commonly used.
Gradual tapering can minimize discontinuation symptoms.

Monitoring & Risks

Boxed warning: Increased suicidality risk in young adults—closer monitoring is common during initiation. Nausea: Most common adverse event.

Somnolence or insomnia: Dose timing is often adjusted.
Sexual dysfunction: Management strategies can be discussed if persistent.
Sweating: Hydration can become a practical issue.
Hyponatremia (SIADH) risk, particularly in elderly; sodium monitoring is common in higher-risk patients.
Bleeding risk can increase when combined with NSAIDs, antiplatelets, or anticoagulants; counseling often covers easy bruising and GI bleeding symptoms.

Drug Interactions

Contraindicated with MAOIs; washout periods are required. Weak CYP2D6 inhibitor—coadministered CYP2D6 substrates may warrant monitoring.

Additive bleeding risk with NSAIDs/anticoagulants.
Caution is common with other serotonergic agents (triptans, tramadol, linezolid) that can raise serotonin syndrome risk.

Practice Notes

Mood and suicidality are commonly reassessed during early therapy and dose changes. Counseling often covers recognizing serotonin syndrome and discontinuation symptoms.

Coordination with mood-stabiliser teams and the bipolar disorder hub can support mania/hypomania risk mitigation in bipolar-spectrum illness.
Measurement-based follow-up (e.g., PHQ-9, GAD-7) can support treatment adjustments; medication is often paired with psychotherapy/skills-based interventions when available.
Dosing time can be individualized: morning dosing may reduce insomnia, while bedtime dosing may reduce daytime fatigue in sedating patients.

References

Lexapro (escitalopram) prescribing information — DailyMed (2026)
Lam2006 Escitalopram Review
CANMAT 2024 Clinical Guidelines for Major Depressive Disorder — Canadian Journal of Psychiatry (2024)