Escitalopram

What Does Escitalopram Do?

Escitalopram is a selective serotonin reuptake inhibitor (SSRI) prescribed for major depressive disorder and generalised anxiety disorder. It's also used off-label for disorders like obsessive-compulsive disorder, panic disorder, social anxiety disorder, and post-traumatic stress disorder. It is also known as Lexapro. It is a newer anti-depressant drug derived from the well-known drug Citalopram. 

How Does Escitalopram Work? (the complicated stuff)

Escitalopram works by increasing the availability of serotonin, a neurotransmitter crucial for mood regulation. Normally, serotonin is released into the synaptic cleft (the space between neurons) to transmit signals and is then reabsorbed by the presynaptic neuron in a process called reuptake. Escitalopram inhibits this reuptake by blocking the serotonin transporter (SERT) protein, leading to higher serotonin levels in the synaptic cleft. This enhanced serotonin signaling helps restore the neurochemical balance often disrupted in depression and anxiety. Although serotonin levels rise quickly, therapeutic effects typically take 2–6 weeks to manifest, likely due to brain adaptations such as changes in receptor sensitivity and neuronal connectivity.

In simpler terms, Escitalopram works by increasing the amount of serotonin in the brain, a chemical that helps regulate mood and emotions. Normally, serotonin sends messages between brain cells and is then reabsorbed. Escitalopram blocks this reabsorption, so more serotonin stays available to improve communication between brain cells. This helps boost mood and reduce feelings of worry or sadness.

Drug Type and Category of Escitalopram

Escitalopram belongs to the drug class known as selective serotonin reuptake inhibitors (SSRIs).

What dosage of Escitalopram should you be taking?

NICE Guidelines ¹

The National Institute for Health and Care Excellence (NICE) provides the following dosage recommendations for escitalopram:

Adults (18–64 years):

• Starting Dose: 10 mg once daily.
• Maintenance Dose: 10–20 mg once daily.
• Maximum Dose: 20 mg once daily.

Older Adults (65 years and above):

• Starting Dose: 5 mg once daily.
• Maintenance Dose: 5–10 mg once daily.
• Maximum Dose: 10 mg once daily.

These guidelines suggest initiating treatment at the lower end of the dosing range, with gradual adjustments based on individual response and tolerability. It's important to note that the maximum recommended dose for older adults is lower due to increased sensitivity to the medication and potential for side effects.

For individuals with reduced liver function, a lower starting dose of 5 mg daily is recommended, with cautious dose adjustments as needed.

What are the side-effects of Escitalopram?

Common Side Effects

These often improve as the body adjusts to the medication:

• Nausea
• Dry mouth
• Drowsiness or fatigue
• Insomnia (difficulty sleeping)
• Increased sweating
• Diarrhea or constipation
• Dizziness
• Headache
• Reduced sexual desire or difficulty achieving orgasm
• Ejaculation problems in men

Less Common Side Effects

These occur less frequently but may still happen:

• Weight changes (loss or gain)
• Blurred vision
• Restlessness or agitation
• Tremors
• Yawning

Serious Side Effects

These are rare but require immediate medical attention:

• Severe allergic reactions (e.g., rash, swelling of the face or tongue, difficulty breathing).
• Serotonin syndrome (symptoms include agitation, confusion, rapid heart rate, high blood pressure, sweating, muscle stiffness, or tremors).
• Severe mood changes (e.g., suicidal thoughts or worsening depression).
• Seizures
• Low sodium levels in the blood (can cause confusion, headaches, or weakness, especially in older adults).

Long-Term Side Effects

• Dependence or withdrawal symptoms if stopped abruptly (e.g., dizziness, irritability, or flu-like symptoms).
• Persistent sexual dysfunction (in rare cases).

Interactions

Other Medications

Serotonergic Drugs:

Combining escitalopram with other serotonergic drugs (e.g., other SSRIs, SNRIs, tricyclic antidepressants, MAOIs, triptans, tramadol, lithium, or St. John’s wort) can increase the risk of serotonin syndrome.

Monoamine Oxidase Inhibitors (MAOIs):

Escitalopram should not be taken with MAOIs or within 14 days of stopping an MAOI, as it can lead to severe and potentially fatal reactions, such as serotonin syndrome.

Blood-Thinning Medications:

Medications like aspirin, warfarin, or other NSAIDs (e.g., ibuprofen, naproxen) may increase the risk of bleeding when used with escitalopram.

CNS Depressants:

Combining with alcohol or sedatives can amplify drowsiness and dizziness.

QT-Prolonging Drugs:

Taking escitalopram with medications that prolong the QT interval (e.g., some antipsychotics, antiarrhythmics, or antibiotics like macrolides) may increase the risk of heart rhythm abnormalities. 

Substances

• Alcohol: Increases sedation and impairs mental alertness.
• Grapefruit Juice: While not a common interaction with escitalopram, it can affect drug metabolism in some individuals.

Medical Conditions

• Liver or Kidney Impairment: Escitalopram clearance may be reduced, requiring dosage adjustments.
• Heart Problems: Those with a history of heart disease, especially long QT syndrome, should use caution.
• Epilepsy or Seizure Disorders: Escitalopram may lower the seizure threshold.
• Low Sodium Levels: Older adults or those taking diuretics are at higher risk for hyponatremia.
• Bipolar Disorder: Escitalopram may trigger a manic or hypomanic episode in individuals with undiagnosed bipolar disorder.

Other Considerations

• Pregnancy and Breastfeeding: Escitalopram may pose risks to the baby, including neonatal withdrawal symptoms or persistent pulmonary hypertension of the newborn (PPHN). Discuss with your doctor if you're pregnant or breastfeeding.
• Caution in Older Adults: Increased sensitivity to side effects such as sodium imbalances and dizziness.

Natural Alternatives to Escitalopram

Herbal Remedies

• St. John’s Wort: Often used for mild to moderate depression, this herb may boost serotonin levels. However, it can interact with many medications, including antidepressants.
• Saffron: Research suggests saffron may improve symptoms of depression and anxiety by affecting serotonin pathways.
• Lavender: Known for its calming properties, lavender can be consumed as tea, used as an essential oil, or taken in capsule form to help with anxiety.
• Ashwagandha: An adaptogenic herb that may help reduce stress and improve symptoms of anxiety and mild depression.

Supplements

• Omega-3 Fatty Acids: Found in fish oil, omega-3s are linked to improved mood and reduced symptoms of depression.
• Vitamin D: Deficiency in vitamin D has been associated with depression, so supplementation might help.
• Magnesium: This mineral plays a role in brain function and mood regulation; magnesium deficiency can contribute to anxiety.
• B Vitamins (especially B6, B9, and B12): These are essential for neurotransmitter production and may help improve mood.
• 5-HTP (5-Hydroxytryptophan): A precursor to serotonin, it may help improve mood and reduce anxiety, but it should not be combined with SSRIs or other serotonergic medications.
• Lifestyle Changes
• Regular Exercise: Physical activity, especially aerobic exercise like walking, running, or swimming, can boost serotonin and endorphin levels, improving mood and reducing anxiety.
• Mindfulness and Meditation: Practices like mindfulness meditation, yoga, and deep breathing exercises can help calm the mind and reduce symptoms of anxiety and depression.
• Sleep Hygiene: Prioritising good sleep habits is critical, as sleep disturbances can worsen mental health symptoms.
• Healthy Diet: A diet rich in whole grains, fruits, vegetables, lean proteins, and healthy fats can support overall brain health.

Other Therapies

• Cognitive Behavioral Therapy (CBT): A non-pharmacological approach that focuses on changing negative thought patterns and behaviors.
• Acupuncture: This traditional Chinese medicine technique may help alleviate symptoms of anxiety and depression.
• Light Therapy: Exposure to natural sunlight or light therapy boxes can help improve mood, especially for seasonal affective disorder (SAD).

Interesting facts about Escitalopram

Escitalopram, a selective serotonin reuptake inhibitor (SSRI), is primarily used to treat major depressive and generalised anxiety disorders. It is a newer and more expensive drug than Citalopram and there are reports that it is more potent, so requires a lower dosage. There are also some reports that it may have slightly less side-effects than Citalopram.

It also benefits a range of conditions including obsessive-compulsive disorder, panic disorder, social anxiety disorder, and post-traumatic stress disorder. Its therapeutic action is due to inhibiting serotonin reuptake in the brain, thus enhancing mood and reducing anxiety. Dosage for adults is usually 10mg daily, increasing to a maximum of 20mg if necessary. However, discussion with a healthcare provider is key when considering its use during pregnancy or breastfeeding. However, always look for natural alternatives to taking medications first, such as improving your general health, exercising, improving your mindset, being positive, being grateful and resolving conflict. 

Disclaimer

This article is generated for informational purposes only. It was created in January 2025. Medications and medical guidance can change over time. Therefore, it is essential to consult with your general practitioner or healthcare provider before making any decisions regarding medications or treatment plans. Your GP can provide personalised advice based on your specific health needs and conditions.

References

1. https://bnf.nice.org.uk/drugs/escitalopram/