What are the common and serious side effects of Lexapro. How does this SSRI antidepressant work for anxiety and depression. Who should be cautious when taking Lexapro. What is the boxed warning for this medication.

Understanding Lexapro: An SSRI Antidepressant for Anxiety and Depression

Lexapro, also known by its generic name escitalopram, is a widely prescribed antidepressant medication belonging to the selective serotonin reuptake inhibitor (SSRI) class. It is primarily used to treat major depressive disorder and generalized anxiety disorder in adults and adolescents aged 12 and older. But how exactly does Lexapro work?

Lexapro functions by increasing the levels of serotonin in the brain. Serotonin is a neurotransmitter that plays a crucial role in regulating mood, emotions, and behavior. By inhibiting the reuptake of serotonin, Lexapro allows more of this neurotransmitter to remain active in the brain, potentially alleviating symptoms of depression and anxiety.

Is Lexapro a Stimulant?

Despite its mood-altering effects, Lexapro is not classified as a stimulant. Stimulants are a different class of drugs that increase alertness, attention, and energy. Lexapro, as an SSRI, works more subtly by modulating neurotransmitter levels rather than providing a stimulant effect.

Common Side Effects of Lexapro in Adults

While Lexapro can be an effective treatment for depression and anxiety, it’s important to be aware of potential side effects. The most common side effects experienced by adults taking Lexapro include:

• Nausea
• Sleepiness or insomnia
• Dizziness
• Dry mouth
• Sweating
• Constipation
• Decreased libido
• Erectile dysfunction

These side effects are generally mild and often subside as the body adjusts to the medication. However, if these symptoms persist or worsen, it’s crucial to consult with a healthcare provider.

Can Lexapro Cause Weight Changes?

The relationship between Lexapro and weight is complex. Some individuals may experience weight gain while taking Lexapro, while others might lose weight. This variability can be attributed to several factors:

1. Improved appetite due to alleviation of depression symptoms
2. Changes in metabolism
3. Individual response to increased serotonin levels

It’s important to note that any significant changes in weight should be discussed with a healthcare provider, as they may need to adjust the treatment plan accordingly.

Lexapro Side Effects in Children and Adolescents

While Lexapro is approved for use in individuals 12 years and older, the side effect profile in younger patients can differ slightly from that in adults. Additional side effects that may be observed in children and adolescents include:

• Increased thirst
• Nosebleeds
• Heavy menstrual periods
• Urination difficulties
• Potential impact on growth and weight

Parents and caregivers should closely monitor children and adolescents taking Lexapro, particularly in the initial stages of treatment or during dosage adjustments. Any concerns about growth or weight changes should be promptly addressed with the prescribing physician.

Serious Side Effects and Boxed Warning for Lexapro

While Lexapro is generally well-tolerated, it does come with a boxed warning – the most serious type of warning issued by the U.S. Food and Drug Administration (FDA). This warning highlights the potential increase in suicidal thoughts and behaviors, particularly in children, adolescents, and young adults during the initial stages of treatment or dosage changes.

What Are the Signs of Increased Suicide Risk?

It’s crucial for patients, family members, and caregivers to be vigilant for signs of increased suicide risk, which may include:

• New or worsening depression or anxiety
• Sudden changes in mood or behavior
• Thoughts of self-harm or suicide
• Increased agitation or restlessness
• Panic attacks

If any of these symptoms occur, it’s essential to seek immediate medical attention or contact emergency services.

Serotonin Syndrome: A Rare but Serious Side Effect

Serotonin syndrome is a potentially life-threatening condition that can occur when there’s an excess of serotonin in the body. While rare, it’s a risk associated with SSRIs like Lexapro, especially when combined with other medications that increase serotonin levels.

What Are the Symptoms of Serotonin Syndrome?

Recognizing the symptoms of serotonin syndrome is crucial for prompt treatment. These may include:

• Agitation or restlessness
• Confusion
• Rapid heart rate
• Dilated pupils
• Excessive sweating
• Muscle rigidity
• High fever

If you suspect serotonin syndrome, seek emergency medical care immediately, as this condition can rapidly become severe.

Lexapro and Sexual Side Effects

Sexual side effects are a common concern for many individuals taking SSRIs, including Lexapro. These effects can include:

• Decreased libido
• Difficulty achieving orgasm
• Erectile dysfunction in men
• Vaginal dryness in women

While these side effects can be distressing, it’s important not to discontinue the medication without consulting a healthcare provider. There are strategies to manage sexual side effects, such as dosage adjustments or additional treatments, that can be explored with medical guidance.

How Long Do Sexual Side Effects Last?

The duration of sexual side effects can vary. For some individuals, these effects may diminish over time as the body adjusts to the medication. For others, they may persist throughout treatment. Open communication with a healthcare provider is key to addressing these concerns effectively.

Managing Lexapro Side Effects: Strategies and Considerations

While side effects can be challenging, there are several strategies that can help manage them effectively:

1. Gradual dosage increases: Starting with a lower dose and gradually increasing it can help minimize initial side effects.
2. Timing of medication: Taking Lexapro at a consistent time each day, either morning or evening, can help regulate side effects.
3. Dietary considerations: Maintaining a balanced diet and staying hydrated can help alleviate some gastrointestinal side effects.
4. Regular exercise: Physical activity can help improve mood and potentially mitigate some side effects.
5. Open communication: Keeping your healthcare provider informed about any side effects is crucial for optimal management.

When Should You Contact Your Doctor About Side Effects?

While many side effects are mild and transient, certain situations warrant immediate medical attention:

• Severe allergic reactions (difficulty breathing, swelling of face or throat)
• Signs of serotonin syndrome
• Unusual changes in mood or behavior
• Persistent or worsening side effects that significantly impact quality of life

Remember, never adjust your dosage or stop taking Lexapro without consulting your healthcare provider, as abrupt discontinuation can lead to withdrawal symptoms.

Lexapro Interactions: Medications and Substances to Avoid

Lexapro can interact with various medications and substances, potentially increasing the risk of side effects or reducing the effectiveness of treatment. It’s crucial to inform your healthcare provider about all medications, supplements, and substances you’re using.

What Medications Should Not Be Taken with Lexapro?

Several medications and substances can interact with Lexapro, including:

• Monoamine oxidase inhibitors (MAOIs)
• Other SSRIs or SNRIs
• Triptans (used for migraine treatment)
• Certain pain medications (e.g., tramadol)
• St. John’s Wort
• Alcohol

This list is not exhaustive, and it’s essential to consult with a healthcare provider or pharmacist about potential interactions before starting any new medication or supplement while taking Lexapro.

Long-Term Effects of Lexapro: What to Expect

While Lexapro is generally considered safe for long-term use, it’s important to be aware of potential long-term effects and considerations:

Can Lexapro Cause Long-Term Changes in Brain Chemistry?

Research on the long-term effects of SSRIs like Lexapro on brain chemistry is ongoing. While these medications are designed to modulate neurotransmitter levels, the full extent of long-term neurological effects is not yet fully understood. Current evidence suggests that for many individuals, the benefits of long-term treatment outweigh potential risks.

Discontinuation Syndrome: What Happens When You Stop Taking Lexapro?

Abruptly stopping Lexapro can lead to discontinuation syndrome, which may include symptoms such as:

• Dizziness
• Flu-like symptoms
• Sensory disturbances (e.g., electric shock sensations)
• Irritability
• Anxiety or agitation

To minimize the risk of discontinuation syndrome, it’s crucial to work closely with a healthcare provider when considering stopping or changing Lexapro treatment. A gradual tapering of the medication is typically recommended.

Lexapro in Special Populations: Pregnancy, Breastfeeding, and Elderly

The use of Lexapro in special populations requires careful consideration and close medical supervision:

Is Lexapro Safe During Pregnancy and Breastfeeding?

The use of Lexapro during pregnancy and breastfeeding is a complex decision that should be made in consultation with a healthcare provider. While some studies suggest potential risks to the fetus or infant, untreated depression during pregnancy can also pose significant risks. The benefits of treatment must be carefully weighed against potential risks on a case-by-case basis.

How Does Lexapro Affect Older Adults?

Older adults may be more sensitive to the effects of Lexapro and may require lower doses. They may also be at increased risk for certain side effects, such as:

• Hyponatremia (low sodium levels)
• Increased risk of falls
• Cognitive impairment

Close monitoring and regular follow-ups are essential for older adults taking Lexapro to ensure safe and effective treatment.

Alternatives to Lexapro: Exploring Other Treatment Options

While Lexapro can be an effective treatment for depression and anxiety, it’s not the only option available. Depending on individual circumstances, alternative treatments may be considered:

What Are Some Non-SSRI Alternatives to Lexapro?

Alternative treatment options may include:

• Other classes of antidepressants (e.g., SNRIs, NDRIs)
• Psychotherapy (e.g., cognitive-behavioral therapy)
• Combination therapy (medication plus psychotherapy)
• Lifestyle modifications (e.g., exercise, stress reduction techniques)
• Alternative therapies (e.g., acupuncture, mindfulness meditation)

The choice of treatment should be based on individual factors, including the severity of symptoms, personal preferences, and potential side effects or contraindications.

Can Natural Remedies Be Used Instead of Lexapro?

While some individuals may explore natural remedies for depression and anxiety, it’s important to approach these options with caution. Some natural supplements, such as St. John’s Wort, can interact with SSRIs and other medications. Always consult with a healthcare provider before incorporating any natural remedies into your treatment plan.

In conclusion, while Lexapro can be an effective treatment for depression and anxiety, it’s crucial to be aware of potential side effects and to work closely with a healthcare provider to monitor treatment progress and address any concerns. By understanding the risks and benefits of Lexapro, patients can make informed decisions about their mental health treatment and optimize their chances of successful outcomes.

What are the side effects of Lexapro?

Doctors prescribe Lexapro for anxiety and depression. It can cause nausea, dizziness, and other side effects in adults. Lexapro can also potentially cause severe side effects, such as suicidal thoughts, and make depression worse.

If you have depression or generalized anxiety disorder, your doctor may want to give you Lexapro. This drug can be very effective in treating either condition. But like all drugs, it may cause side effects. Some of these may only be bothersome, while others may be severe and impact your health.

Learning about the side effects can help you decide if the drug is right for you. Here’s an overview of the side effects Lexapro can cause.

Lexapro is a prescription drug. It’s available as an oral tablet and an oral liquid solution. It’s approved for use in adults and children 12 years and older.

The medication belongs to the class of drugs called selective serotonin reuptake inhibitors (SSRIs). It works by increasing the amount of the chemical serotonin in your brain. Having more serotonin helps decrease the symptoms of depression and anxiety. Lexapro is not considered a monoamine oxidase inhibitor (MAOI). MAOIs work by slowing down the breakdown of serotonin and dopamine, another chemical in your brain. This also helps alleviate symptoms of depression. However, MAOIs have a higher risk of side effects and drug interactions than SSRIs such as Lexapro.

SSRIs, including Lexapro, are tolerated well compared to other types of antidepressants. In general, you may have more side effects if you take a higher dosage of the drug. At a high dosage, Lexapro is more likely to cause gastrointestinal side effects, such as diarrhea.

Common side effects

The side effects of Lexapro seem to be the same in both men and women. The side effects are slightly different for adults and children.

Adult side effects can include:

• nausea
• sleepiness
• weakness
• dizziness
• anxiety
• sleeping trouble
• sexual problems, such as decreased sex drive and erectile dysfunction
• sweating
• shaking
• loss of appetitive
• dry mouth
• constipation
• infection
• yawning

The side effects for children and adolescents can include the above, plus:

• increased thirst
• abnormal increase in muscle movement or agitation
• nosebleeds
• trouble urinating
• heavy menstrual periods
• slowed growth and weight change

There have been some cases of decreased appetite and weight loss with the use of Lexapro in children and adolescents. Your child’s doctor may check their height and weight during treatment.

People with depression tend to have a low appetite and reduced body weight. In adults, some sources say Lexapro may cause a small amount of weight gain. However, if you gain weight, your weight may just be evening out because your depression is better managed and your appetite has returned. Other people lose weight when they’re taking Lexapro. The increase in serotonin may lead to loss of appetite.

Most of these side effects are mild. They should eventually go away on their own without treatment. If they’re more severe or don’t go away, tell your doctor.

Boxed warning side effects

A boxed warning is the most serious warning from the U.S. Food and Drug Administration (FDA).

Lexapro may increase suicidal thoughts or actions. This risk is higher in in children, teenagers, or young adults. This is more likely to happen within the first few months of treatment or during dosage changes.

Call your doctor right away if you have any of the following symptoms, or call 911 or local emergency services if the symptoms are new, worse, or worrisome:

• attempts to commit suicide
• acting on dangerous impulses
• aggressive or violent actions
• thoughts about suicide or dying
• new or worse depression
• new or worse anxiety or panic attacks
• feeling restless, angry, or irritable
• trouble sleeping
• increased activity (doing more than what is normal for you)
• other unusual changes in your behavior or mood

Other serious side effects

Lexapro can also cause other serious side effects. Call your doctor right away if you have serious side effects. Call 911 or local emergency services if your symptoms feel life-threatening or if you think you’re having a medical emergency.

Severe allergic reactions

You should not take Lexapro if you’re allergic to it, its ingredients, or the antidepressant Celexa. Symptoms can include:

• breathing trouble
• swelling of your face, tongue, eyes, or mouth
• severe rash, hives (itchy welts), or blisters that may come on with fever or joint pain

Seizures or convulsions

There have been reports of some people having seizures while taking Lexapro. People with a history of seizures are at higher risk.

Serotonin syndrome

This is a serious condition. It happens when the levels of serotonin in your body get too high. It’s more likely to occur if you also take other drugs that increase serotonin, such as other antidepressants or lithium. Symptoms can include:

• agitation
• hallucinations (seeing or hearing things that aren’t real)
• coma (loss of consciousness)
• coordination problems, overactive reflexes, or muscle twitching
• racing heart rate
• high or low blood pressure
• sweating or fever
• nausea, vomiting, or diarrhea
• muscle stiffness

Low salt levels

Lexapro may cause low salt levels in your body. This may be more likely to occur in seniors, people who take water pills, or people who are dehydrated. This side effect may cause:

• headache
• confusion
• trouble concentrating
• thinking or memory problems
• weakness
• unsteadiness that can lead to falls
• seizures

Manic episodes

If you have bipolar disorder, Lexapro may cause you to have a manic episode. Taking Lexapro without another drug for bipolar disorder may trigger an episode. Symptoms can include:

• greatly increased energy
• severe sleeping trouble
• racing thoughts
• reckless behavior
• unusually grand ideas
• excessive happiness or irritability
• talking quickly or more than normal

Vision problems

Lexapro may dilate your pupils. This may trigger a glaucoma attack, even if you don’t have a history of eye problems. Symptoms can include:

• eye pain
• changes in your vision
• swelling or redness in or around your eye

Side effects with other health conditions

If you have certain health conditions, you likely should not take Lexapro. In some cases, your doctor may lower your dosage or watch you more closely during your treatment with it. Tell your doctor if you have any of the following health conditions before taking Lexapro.

• A history of suicidal thoughts or behaviors—Lexapro can increase the risk of suicidal thinking and behavior, especially in children, teens, and young adults.
• Bipolar disorder—if you take Lexapro without taking other medications for bipolar disorder, Lexapro may bring on a manic episode.
• Seizures—this drug may cause seizures and make your seizure disorder worse.
• Glaucoma—this drug may bring on a glaucoma attack.
• Low salt levels—Lexapro can further lower your salt levels.
• Pregnancy—it isn’t known if Lexapro will harm your unborn baby.
• Breastfeeding—Lexapro may pass into breast milk and cause side effects in a child who is breastfed.

Certain medications can interact with Lexapro. Be sure to tell your doctor about all over-the-counter and prescription drugs, supplements, and herbs you take. Lexapro may interact with the following drugs:

• blood thinners such as warfarin to increase your risk of bleeding
• nonsteroidal anti-inflammatory drugs (NSAIDs) and aspirin to increase your risk of bleeding
• other drugs used to treat depression to increase the level of serotonin in your body, which can cause serotonin syndrome

Lexapro is a powerful drug used to treat depression and anxiety. While it can be very effective, it may also cause side effects. Be sure to tell your doctor about other health conditions you have and medications you take before starting Lexapro. This information can help your doctor reduce your chance of side effects. Also tell your doctor if you do have any side effects. If you can’t tolerate the effects, your doctor may change your medication. Keep in mind that Lexapro and other drugs in its class cause many of the same side effects.

How Long Does It Take For Lexapro To Work?

Lexapro is a brand name version of an antidepressant called escitalopram.

As of 2019, more than 6 million people in America take Lexapro to improve their mood, emotional regulation, and energy levels.

If your doctor prescribes you Lexapro for depression or anxiety, it can take some time to start working.

In this article, I’ll tell you how long it typically takes for this medication to start working.

I’ll also explain what Lexapro is, what it’s used to treat, how it works, and list some of its potential side effects.

I’ll also tell you when to talk to your doctor.

What is Lexapro?

Lexapro is a type of antidepressant called a selective serotonin reuptake inhibitor, or SSRI.

SSRIs increase levels of serotonin in the brain, which can improve mood and emotional regulation.

This benefits people with clinical depression and anxiety.

Lexapro is extremely popular in the United States. This is partially due to its low cost. 

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What Lexapro can treat

Lexapro is typically prescribed to treat the following conditions: 

• Major depressive disorder (MDD): Young people aged 12 to 17 are prescribed Lexapro as either a short-term (acute) or long-term (maintenance) treatment for major depressive disorder, sometimes called clinical depression.

•  Generalized Anxiety Disorder: Adults also take Lexapro to treat clinical anxiety disorders such as generalized anxiety disorder.

Lexapro is sometimes prescribed for other psychological and mood disorders including, but not limited to:

• Obsessive-compulsive disorder (OCD)
• Social anxiety disorder
• Panic disorder
• Seasonal affective disorder
• Eating disorders, including binge-eating disorder and bulimia nervosa
• Post-traumatic stress disorder (PTSD)

Lexapro is not prescribed for mood disorders that involve mania, like bipolar disorder, as it can affect emotional cycles. Lexapro is not safe for pregnant women. 

How Does Lexapro Work?

Lexapro is a type of antidepressant called a selective serotonin reuptake inhibitor, or SSRI.

Serotonin is a type of chemical called a neurotransmitter.

Neurotransmitters are responsible for sending messages to areas of the brain that regulate important bodily processes like appetite, sleep, pain sensation, and mood regulation. Under normal circumstances, when a neurotransmitter finishes carrying its message, it is recycled by the brain, a process called “reuptake.”

Lexapro acts on a part of the brain that controls serotonin levels, called reuptake sites.

This inhibits the recycling of serotonin at these sites so that they remove less serotonin at a time, leaving more serotonin in your brain.

This can help balance the amount available in the brain, alleviating depression symptoms.

Short-term treatments

When used as part of acute, or short-term, treatments, Lexapro can assist in coping with short-term problems from acute depression to grief.  

Long-term treatments

For maintenance, or long-term, treatments, Lexapro helps regulate things like anxiety disorders for a longer time period, sometimes indefinitely.

Usually only adults are prescribed Lexapro for long-term treatments.

How Long Does it Take to Work?

When you take Lexapro (or its generic version, escitalopram), your body metabolizes it and changes your brain function in a matter of hours.

Physiological effects begin almost immediately, and many people notice a change quickly.

Even though the medication begins to take effect from the first day it’s administered, people may notice the results of its effects at different times.

Different people notice changes after differing periods. Most people report that they feel the effects of their medication after 4 weeks of consistent treatment. 

For people who feel the effects of Lexapro quickly, it may be due, in part, to a placebo response.

When someone feels very strongly that the medication will be helpful for them, they may notice changes within days or even hours after taking Lexapro.  

Other people may not notice the influence of Lexapro for up to 6 weeks.

This does not mean that the medication is not working, but rather that some people take longer to notice a difference.

If you feel worse after taking Lexapro or notice no change at all after this time, talk with your doctor about the next steps or switching medications. 

Potential Side Effects

If you are taking or will be taking Lexapro, you may experience some side effects.

These effects often go away after a few weeks.

Talk to your doctor or healthcare provider if they do not go away, or if they start to affect your daily life negatively.

Studies show that people who take Lexapro sometimes report the following common side effects:

• Dizziness, drowsiness, or weakness
• Sleep problems (insomnia)
• Dry mouth
• Nausea
• Constipation
• Headaches

Weight gain, reduced sex drive, and sexual dysfunction are common issues that may prevent some from using Lexapro as a treatment.  

SSRIs also affect your metabolism, sometimes leading to weight changes.

Weight gain and sexual changes resulting from taking Lexapro do not typically go away with time, but may stop after stopping taking Lexapro.

Combining Lexapro with other medications or substances can also increase risks. 

Do not take Lexapro if you are also taking pimozide (Orap), or if you have a known allergy or hypersensitivity to escitalopram or citalopram (Celexa). 

Other drugs and treatments can interact with Lexapro in dangerous or fatal ways.

Medications known to interact with Lexapro include, but aren’t limited to:

• Stimulant medicines
• Blood thinners
• Opioid medicines
• Medications for Parkinson’s disease
• Medications for migraine headaches
• Medications for serious infections
• Medications preventing nausea and vomiting

Always talk with your doctor about your medical history, and tell them about everything you take, before beginning a new medication.  

When to See a Doctor

Suicidal ideation is a rare side effect of Lexapro in young adults.

In treatments for children and young adults ages 12-17, keep an eye out for warning signs of an increase in depression symptoms like isolation and apathy. 

Another rare side effect of SSRIs like Lexapro is serotonin syndrome, which is an overload of serotonin in your brain.

Serotonin syndrome is characterized by the following symptoms:

• Muscle spasms
• Rapid changes in blood pressure or heartbeat
• Vomiting
• Hallucinations

Serotonin syndrome is considered a medical emergency, so if you experience these symptoms, seek emergency medical help immediately. 

In rare cases, people find out that they are allergic to Lexapro, escitalopram or citalopram as they are taking it.

An allergic reaction to these medications has these symptoms:

• Rashes
• Itching
• Swelling in the face, hands, ankles, or feet
• Swelling inside the mouth or throat
• Chest pain or tightness
• Shortness of breath or wheezing

An allergic reaction to Lexapro or other SSRI medications is also considered a medical emergency, and you should immediately seek medical help.  

If you’re having a mental health emergency, call 911 or go to the nearest emergency room. You can also get free 24/7 support from a suicide and crisis expert by calling or texting 988. If you’d prefer to chat online, you can chat with a suicide and crisis expert by visiting the Lifeline Chat.

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Get started with our free assessment, which will tell you in minutes if treatment could be a good fit. If yes, we’ll connect you right to a clinician who can prescribe medication and have it shipped right to your door.

Frequently Asked Questions

Can you feel the effects of Lexapro immediately?

Most people report feeling the effects of their Lexapro within 4 weeks. It can take some people as little as a day or as long as 6 weeks to feel the effects of their treatment. This is because different people notice the influence of medication at different times.

How does Lexapro make you feel the first week?

Everybody reacts to medication differently. If you are very sensitive to changes in your body and system, you may notice Lexapro’s effects the next day. If you are less likely to notice changes in your sleep, appetite, or mood, it may take much longer to tell that you are under the influence of Lexapro. Your body is still getting used to a new treatment and medication, which can have some side effects. If you feel more serious side effects like suicidal ideation or serotonin syndrome, stop taking the medication immediately and seek emergency medical help.

Is Lexapro best for anxiety?

Lexapro is commonly prescribed for both anxiety and depression. This is because it has positive effects on serotonin levels in the brain, which helps regulate mood.

Is Lexapro fast acting?

When Lexapro is administered, it immediately begins to spread through your body. In the brain, it will begin increasing serotonin levels. It will take you some time to notice a difference, even though your brain is already changing.

K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

K Health has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions,
and medical associations. We avoid using tertiary references.

• MEPS HC-213A: 2019 Prescribed Medicines File. (2021).
  https://meps.ahrq.gov/mepsweb/data_stats/download_data_files_detail.jsp?cboPufNumber=HC-213A

• The Expanded Biology of Serotonin. (2018).
  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5864293/

• Antidepressant discontinuation syndrome. (2017).
  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5449237/

• Serotonergic Modulation of Intrinsic Functional Connectivity. (2014).
  https://www.sciencedirect.com/science/article/pii/S0960982214010379

• The Timing of Antidepressant Effects: A Comparison of Diverse Pharmacological and Somatic Treatments. (2010).
  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3991019/

• Antidepressants and Suicide in Adolescents and Adults: A Public Health Experiment with Unintended Consequences? (2009).
  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2799109/

possible causes and alternative treatments

If antidepressants don’t help your depression, don’t lose hope. In the article, you will learn what other methods of treatment exist and how to choose an effective solution for yourself.

Antidepressants are one of the most commonly used medications for depression and other mental disorders. However, not all people receive the expected help from them. In this case, it becomes necessary to look for alternative ways to deal with mental disorders and understand why a particular person does not get the desired effect from the use of antidepressants.

There are several reasons why medicine may not work. In some cases, this is due to the individual characteristics of the patient’s body, and in others – with an insufficient dosage or an incorrectly selected drug. You will learn about this from this article.

In addition to drugs, there are alternative methods of dealing with depression and other mental disorders. In this article, we will talk about what methods help people who cannot get the desired effect from the use of antidepressants. This can be useful not only for those who have already encountered this problem, but also for those who are looking for effective ways to deal with depression.

Rethink your attitude to medicines

When we get sick, we go to the doctor to prescribe us medicines. But sometimes, even with the right treatment, we do not feel a complete recovery. Then we start traveling to different doctors and end up on a course of antidepressants. However, if you still don’t feel better after several months of taking antidepressants, it may be worth rethinking your relationship with medications and trying other treatment approaches.

The first step to change your mindset is to learn about alternative treatments for depression. For example, many patients benefit from psychotherapeutic methods such as cognitive behavioral therapy. Simply put, it is training the brain to focus on the positive aspects of life rather than the negative ones. Meditation and yoga can also work effectively to reduce stress and anxiety.

However, if you still need to take drugs, talk to your doctor about changing your dose or changing the drug. Some patients may react to more than one opposite antidepressant, so you may need to do more testing to see which drug is right for you.

Whether you choose alternative methods or stay on medication, remember that any change will take time. Everything you do should be under the supervision of your doctor. Discuss your options in detail with your healthcare professional to determine the most effective and safest approach to treating your depression.

Learn about possible side effects of antidepressants

When using antidepressants, be aware that their use may cause side effects. Therefore, before starting treatment, it is necessary to familiarize yourself with the possible0003

kami and monitor how you feel while taking the medication.

The main side effects of antidepressants are: drowsiness, dry mouth, constipation, nausea, headache, insomnia, loss of appetite or vice versa, its increase, changes in libido and others.

If you feel that the side effects are too severe, be sure to contact your doctor who can suggest alternative treatment options or adjust your dosage.

It is important to remember that antidepressants have serious effects on the body and may interact with other medications. Therefore, antidepressants should be taken only under the supervision of a doctor and in compliance with all recommendations for the use of drugs.

Some side effects of antidepressants can reduce a patient’s quality of life. In such cases, consider using alternative therapies such as psychotherapy, exercise, meditation, lifestyle changes, etc. In general, alternative therapies have fewer side effects and may be more effective in the long run.

Specify the dosage of the antidepressant

One of the possible reasons for the lack of effect of taking antidepressants may be the wrong dosage.

The dosage of antidepressants should be individualized depending on the type and severity of depression, as well as a number of other factors such as age, weight and physiology. Sometimes the prescribed dose may be insufficient or excessive for a particular patient.

If you suspect that your antidepressant dosage is not correct, be sure to discuss this with your doctor. The best option may be to adjust the dosage or change the drug to another, more suitable one.

It is important to remember that it is not recommended to change the dosage of an antidepressant and change the medication on your own. The decision to adjust the dosage or change the antidepressant should be made only by a doctor and based on the results of tests and examinations.

Change the type of antidepressant

If one type of antidepressant does not work well, you can turn to other types of these drugs. For example, if a certain Selective Serotonin Reuptake Inhibitor (SSRI) has been taken, prescribing monoamine oxidase inhibitors (MAOIs) may help.

In addition, there are newer antidepressants that may be more effective. For example, serotonin and norepinephrine reabsorption inhibitors (NSRIs) or atseclopram.

Keep in mind that not all antidepressants are equally effective for all people. So, in the absence of a strong effect from one drug, be sure to choose a more suitable one in your case.

• Selective serotonin reuptake inhibitors (SSRIs): Fluoxetine (Prozac), Sertraline (Zoloft), Paroxetine (Paxil), Escitalopram (Lexapro/Cipralex).
• Monoamine oxidase inhibitors (MAOIs): Isocarboxazid (Marplan), Phenelzine (Nardil), Trancipromine (Parnate), Selegiline (Emsam).
• Serotonin and norepinephrine reabsorption inhibitors (SNRIs): Duloxetine (Cymbalta), Venlafaxine (Effexor), Dezvenlafaxine (Pristiq).

Contact your doctor

If you are using antidepressants and you are not seeing results, be sure to contact your doctor. Don’t think it’s normal and just keep waiting for the medication to work.

Your doctor may suggest that you change your antidepressant or increase your dose. There may also be other reasons why the medicine does not give the desired result, which can only be revealed during examination and consultation with a doctor.

Do not continue taking antidepressants if they do not work. In this case, you should contact your doctor, who will give professional advice and help you find alternative treatments, if necessary.

Remember that self-medication can be dangerous and unpredictable. Communicate openly and honestly with your doctor so that he can help you determine the best course of treatment for your particular situation.

Change your lifestyle

Antidepressants may work in conjunction with lifestyle changes. Problems that can cause depression can include acute or chronic stress, lack of sleep, inactive lifestyle, poor diet, and more. Changing your lifestyle can help you manage depression and even stop using antidepressants.

Regular physical activity:

It can help relieve stress, improve mood and promote overall health. Try going for walks every day, going to the gym, or doing yoga.

Good nutrition:

Foods containing vitamins B, D and magnesium can help improve your mood. Try to increase your intake of vegetables, fruits, and protein foods.

Regular sleep:

Normal sleep, which lasts from 7 to 8 hours, can help manage stress and improve mood. Try to go to sleep and wake up at the same time every day, avoid caffeine, alcohol and nicotine at night.

Maintain social connections:

Spend time with friends and family. Exchange feelings and ideas and get support from your environment.

Learn to manage stress:

Try various stress management techniques such as breathing exercises, meditation, yoga, time management and energy exercises.

Remember that changing your lifestyle can take time and effort, but it can help you improve your mental health and reduce your need for antidepressants.

Use CBT

Cognitive Behavioral Therapy (CBT) is an effective treatment for depression and other mental disorders. Unlike antidepressants, which focus on the physiological aspects of the disease, CBT is used to change habitual thought patterns and behavioral responses.

CBT can include a variety of techniques such as setting goals, planning activities, and working to change mindset and perspective. The ultimate goal is to present changes in situations that can lead to depression and other mental disorders in a more realistic and positive light.

CBT not only helps with mind-altering, it can also enhance the effect of antidepressants when used in combination with them. Moreover, many patients find that CBT gives them more control over their condition and behavior, which can reduce feelings of powerlessness and helplessness.

If antidepressants don’t help, see a psychotherapist who can help determine if CBT is right for you and develop a personalized treatment plan.

Try meditation

Meditation is a mind and sense control practice that can help fight depression and anxiety. Many studies have shown the positive effects of meditation on mental health. As a result, meditation can be an effective adjunct to therapy and medication.

One of the most common and easiest meditations to start is concentration meditation. First, sit in a comfortable place and close your eyes. Watch your breath as you try to focus your mind on your inhalations and exhalations. If your attention wanders, bring it back to your breath. Repeat this practice every day, gradually increasing the time for meditation.

There are also group meditations, such as yoga, which can provide a structured and motivating experience for beginners or those who find it difficult to concentrate alone. Look for places where group meditations are held in your area and join.

Meditation is a simple and effective way for those who want to reduce stress and anxiety, increase the ability to concentrate and focus. Try incorporating meditation into your mental health regimen.

Consider Aromatherapy

Aromatherapy is a treatment that uses plant-derived essential oils to improve a person’s health and well-being. These oils contain powerful chemical compounds that have a positive effect on our emotions, physical condition and our mind.

The main idea of ​​aromatherapy is that smells can affect the entire body and help it solve various problems. Different oils are used for different purposes, from improving mood to relieving pain. For aromatherapy, essential oils can be used as bath additives, massage oils, inhalers, and scented candles.

Although aromatherapy is not a substitute for primary therapy, it can help improve the effectiveness of treatment and relieve some of the symptoms of depression. For example, you can use lavender oil, which helps reduce anxiety and mood. Peppermint oil – improves mood and increases energy.

Aromatherapy has no serious side effects and is often used as part of a comprehensive treatment for depression. To achieve the maximum effect, it is necessary to contact certified specialists to choose the right oil and set up an individual treatment program.

Learn Hypnotherapy Techniques

Hypnotherapy is an alternative treatment that uses powerful hypnosis techniques to create changes in the patient’s subconscious mind and help them deal with various problems including depression, anxiety, phobias, and more.

Although hypnotherapy is not a scientifically recognized treatment for depression, it can still help some patients who are not getting the desired effect from their antidepressants.

A hypnotherapist can use a variety of techniques, including deep relaxation, visualization, and auto-suggestion, to help the patient change their thoughts and behavior in a more positive direction.

However, before beginning hypnotherapy, it is important to consult a qualified hypnotherapist to make sure that this technique is safe for your health.

In any case, hypnotherapy can be an effective addition to other treatments for depression and can help you deal with problems that other treatments have not resolved.

Enjoy music therapy

Music therapy is a method of treating mental and physical illnesses with the help of musical instruments, songs, sounds and sound compositions. This method allows you to reduce stress levels, improve mood and increase concentration. Music therapy can be used as an alternative to antidepressants if they are not effective.

Acoustic guitar, flute, keyboards and other instruments are often used in music therapy. A person performing musical compositions can influence the patient’s psycho-emotional state. Also in music therapy, computer processing of sounds is used to create special sound compositions that can affect the human condition.

One of the advantages of music therapy is its accessibility. It can be used even at home, listening to your favorite music and psychological compositions. Modern technologies allow you to choose psychoactive compositions that you can listen to throughout the day, while not being distracted from work and without disturbing the daily routine.

In most cases, music therapy is a safe and effective treatment for depression. It can be used alone or in combination with other treatments such as psychotherapy or antidepressants.

• Benefits of music therapy:
• Reduced stress levels;
• Mood enhancement;
• Improving physical and mental health;
• Improved quality of life;
• Immune system support.

Try treatment here and now

If antidepressants don’t help your depression, don’t despair. There are alternative treatments that can help you overcome this disease.

Talk to a psychotherapist . Psychological treatment can be an effective way to deal with depression. An experienced therapist will help you understand the causes of your problems and teach you how to use psychological methods to improve your mood and reduce the symptoms of depression.

Change your lifestyle . Try to move more, play sports, monitor nutrition and sleep patterns. It is also important to learn how to relax and control your thoughts so as not to sink into negative memories and emotions.

Try alternative treatments . Some people report beneficial effects on their mental health from yoga, meditation, aromatherapy, acupuncture, or massage. Do not be afraid to try something new if you are already used to the usual treatment with antidepressants.

Ask friends and family for help . Feel free to connect with the people you care about. Talk to someone about your problems, ask for advice and support. Sometimes, just communication and understanding can help in coping with difficulties.

Remember that there is no one-size-fits-all cure for depression. All people are individuals and each must find their own path to recovery. The main thing is not to give up and do everything possible to overcome your disease.

Explore Transcranial Magnetic Stimulation

Transcranial Magnetic Stimulation (TMS) is a non-invasive procedure that uses magnetic energy to stimulate nerve cells in the brain. It may be useful for treating depression, anxiety, Parkinson’s disease, Huntington’s disease, epilepsy, and other mental health disorders.

TMS is performed in a special room where the patient sits in a chair and wears a special coil on his head. When the coil is connected to a magnetic pulse generator, it creates a magnetic field that penetrates the skull and stimulates the neurons in the brain.

Within a few sessions, TMS may reduce symptoms of depression or other mental illness. TMS is generally safe, although some patients may experience minor side effects such as headaches or discomfort during the procedure.

It is important to remember that TMS is not a panacea for depression and other mental illnesses. It may help some patients, but is not necessarily suitable for everyone. If you are suffering from depression or other mental illness, see your doctor for advice on the therapy that is best for you.

Explore herbal medicine

Herbal medicine is an alternative approach to treating depression and anxiety with herbal remedies. Many herbal preparations contain natural ingredients that can improve mood, reduce anxiety, and increase resilience to stress.

Popular herbs used in herbal medicine include saffron, valerian root, geranium herb, rose petals, ginseng and turmeric. These plants contain beneficial substances that can improve mood and nervous system function.

If you would like to try herbal medicine, please contact a naturopathic or homeopathic specialist. These doctors are highly experienced in the use of herbal medicines and can tailor a personalized treatment plan for you.

However, do not forget that not all herbal preparations are equally good for everyone. Some herbs may cause side effects including headache, nausea, and dizziness. Therefore, before using herbal medicine, be sure to consult with your doctor.

Some herbs can interact with other medicines and cause unwanted effects on your health. Also, if you are allergic to certain plants, use the herb with caution or refrain from using it at all.

Remember that herbal medicine is not a substitute for antidepressants and other medications. However, taking herbal supplements in combination with conventional treatments can help improve your mood and reduce your anxiety levels.

See a therapist

If antidepressants don’t work, see a therapist. He can help you understand the causes of your mental condition, as well as share techniques for dealing with depression.

When choosing a psychotherapist, it is recommended to contact professionals with experience and a good reputation. Also pay attention to the methods the therapist uses and choose the one whose methods best suit your needs.

Psychotherapy can include both individual and group sessions. The choice depends on your preferences and the specific situation.

It is important to remember that the results of psychotherapy do not appear instantly, and sometimes it may take several sessions to achieve a positive effect. But do not despair – this technique can help you overcome depression and return the joy of life.

Consider electroshock treatment

Electric current has a long history of medical use and may be useful in treating depression. Electroconvulsive therapy (ET) uses a controlled electrical current to create convulsive responses in the brain. The procedure uses anesthesia, which makes it painless.

In addition to the various side effects of antidepressants (AD), they may not work effectively for everyone with depression. ET may be a good choice to explore if other methods have also failed.

Although ET is a safe and effective procedure, it can cause certain side effects such as headache, muscle pain, and memory that usually only affect short-term memory.

Moreover, according to a 2018 JAMA Psychiatry study, ET may be more effective in more severe cases of depression, especially in those who do not respond to highly effective ADs such as serotonin or norepinephrine reuptake inhibitors.

If you are not sure if ET is right for you, talk to your doctor and consider all of your treatment options. It will also help you choose the best treatment strategy.

Try Alternative Therapies

One alternative treatment option is psychotherapy. Its purpose is to help the patient sort out their thoughts and emotions, as well as learn how to cope with stress. Cognitive behavioral therapy (CBT) may be helpful for those suffering from depression. As part of CBT, the patient sometimes learns to analyze their thoughts and cope with negative feelings.

However, in addition to therapy, one can pay attention to physical methods. Regular exercise can help improve your mood and boost your happiness hormones. Yoga, meditation and other types of mental relaxation can reduce stress and improve sleep quality, which is also important for brain health and general physical condition.

If antidepressants don’t help, you can turn to natural remedies. Some herbs, such as sage and valerian root, can help improve mood without the side effects associated with pharmaceutical drugs. There are also various methods of aromatherapy and massage that help restore psychological balance.

It is important to remember that treatment decisions should only be made after consulting a specialist. A good doctor will help you choose the best method of treatment and control the process until complete recovery.

Related videos:

Q&A:

What if antidepressants don’t help?

If antidepressants do not help, then you should contact a psychotherapist or psychiatrist for advice and prescribe additional therapy.

What could be the reasons for the ineffectiveness of antidepressants?

Failure of antidepressants may be due to improper dosing, incorrect choice of drug, comorbidities or psychological problems, or resistance to the antidepressant effect.

What is antidepressant resistance?

Antidepressant resistance is a state in which the body stops responding to the drugs used due to adaptation to their action. This may occur due to long-term use, switching to another drug, or due to individual physiological characteristics.

What alternative treatments are available for depression?

Alternative treatments for depression include psychological therapy, exercise, including yoga and dancing, proper nutrition and sleep, meditation and relaxation, and other drug groups.

How important is the role of nutrition and sleep in the treatment of depression?

Proper nutrition and sleep are important factors influencing our psychological and physical health. When treating depression, they can help improve a patient’s general condition, increase energy levels and mood, and improve quality of life.

What is CBT and how can it help with depression?

Cognitive behavioral therapy is a method of psychotherapy based on changing the patient’s thinking and behavior. It can help with depression, as it allows the patient to better understand their thoughts and emotions, learn to control their reactions and behavior in difficult situations, and develop new skills and evaluation criteria.

What is the role of exercise in the treatment of depression?

Exercise stimulates the release of endorphins, hormones responsible for good mood and well-being. They also help to eliminate nervous tension, reduce stress levels and improve the general condition of the patient.

Memorial Sloan Kettering Cancer Center

Adult Medication

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This document, provided by Lexicomp ^® , contains all the information you need to know about this medicine, including indications, directions for use, side effects, and when your healthcare provider should be contacted.

Trade names: USA

Lexapro

Trade names: Canada

ACH-Escitalopram; ACT Escitalopram ODT; AG-Escitalopram; APO Escitalopram; Auro Escitalopram; BIO-Escitalopram; Cipralex; KYE-Escitalopram; M-Escitalopram; Mar-Escitalopram; MINT-Escitalopram; MYLAN-Escitalopram; NAT-Escitalopram; NRA-Escitalopram; PMS-Escitalopram; PMSC-Escitalopram; RIVA Escitalopram; SANDOZ Escitalopram; TARO-Escitalopram; TEVA-Escitalopram

Warning

For all patients taking this drug:

• Drugs like this have increased the likelihood of suicidal thoughts or actions in children and young people. This risk may be higher in people who have tried or had suicidal thoughts in the past. All people taking this drug must be closely monitored. If you develop or worsen disorders such as depression, nervousness, anxiety, grouchiness, panic attacks, and changes in mood or behavior, contact your doctor immediately. Contact your doctor immediately if you have suicidal thoughts or suicide attempts.

Children:

• This drug is not approved for use in children of all ages. Check with your doctor to make sure this drug is right for your child.

What is this drug used for?

• Used to treat depression.
• Used to treat anxiety.
• This drug may also be used for other indications. Consult your doctor.

What should I tell my doctor BEFORE taking this drug?

• If you have an allergy to this drug, any of its ingredients, other drugs, foods or substances. Tell your doctor about your allergies and how they have manifested.
• If you are taking any of the following drugs: linezolid or methylene blue.
• If you are taking one of the following drugs: citalopram or pimozide.
• If you have taken medications for depression or Parkinson’s disease in the past 14 days. These include isocarboxazid, phenelzine, tranylcypromine, selegiline, or rasagiline. An episode of very high blood pressure may occur.

This list of drugs and conditions that may interact with this drug is not exhaustive.

Tell your doctor and pharmacist about all medicines you take (prescription and over-the-counter, natural products and vitamins) and any health problems you have. You need to make sure that this drug is safe for your conditions and in combination with other drugs you are already taking. Do not start or stop taking any drug or change the dosage without your doctor’s advice.

What do I need to know or do while taking this drug?

• Tell all your health care workers that you are taking this drug. These are doctors, nurses, pharmacists and dentists.
• Avoid driving and other activities that require increased attention until you see how this drug affects you.
• Do not stop taking this drug abruptly without consulting your doctor. This can increase the risk of side effects. If necessary, taking this drug should be stopped gradually, in accordance with the recommendations of the doctor.
• Avoid drinking alcohol while taking this drug.
• Check with your doctor before using marijuana, other forms of cannabis, or prescription or over-the-counter drugs that can slow you down.
• Depression may improve sleep and appetite quickly after starting this drug. It may take up to 4 weeks to relieve other symptoms of depression.
• This drug may increase the risk of bleeding. Sometimes bleeding can be life-threatening. Consult your doctor.
• This drug may cause low sodium levels. Very low sodium levels can be life-threatening, leading to convulsions, fainting, difficulty breathing, or death.
• If you are 65 years of age or older, use this drug with caution. You may experience more side effects.
• In some cases, the drug may affect the growth rate in children and adolescents. They may need regular growth rate checks. Consult your doctor.
• Tell your doctor if you are pregnant, planning to become pregnant, or breastfeeding. The benefits and risks for you and your child will need to be discussed.
• Taking this drug during the third trimester of pregnancy may cause some health problems in the newborn. Consult your doctor.

What side effects should I report to my doctor immediately?

WARNING. In rare cases, this drug can cause serious and sometimes deadly side effects in some patients. Call your doctor right away or get medical help if you have any of the following signs or symptoms that could be associated with serious side effects:

• Signs of an allergic reaction, such as rash, hives, itching, red and swollen skin with blisters or peeling, possibly accompanied by fever, wheezing or wheezing, tightness in the chest or throat, difficulty breathing, swallowing or speaking, unusual hoarseness, swelling in the mouth, face, lips, tongue or throat.
• Signs of low sodium levels such as headache, trouble concentrating, memory impairment, confused thinking, weakness, seizures, problems with balance.
• signs of bleeding, such as vomiting or coughing up blood; vomiting of the type of coffee grounds; blood in the urine; black, red, or tarry stools; bleeding from the gums; non-cyclic vaginal bleeding; bruises that appear or increase for no reason; bleeding that you cannot stop.
• Seizures.
• Fever or chills.
• Painful erections or erections that last more than 4 hours.
• Against the background of taking such drugs, violations of sexual function were noted. These included decreased interest in sex, problems achieving orgasm, problems ejaculating, or problems getting or maintaining an erection. If you have any questions, please consult your doctor.
• Some patients may be at increased risk of eye problems when using this drug. Your doctor may order an eye examination to see if you are at increased risk for these eye problems. Call your doctor right away if you have eye pain, vision changes, swelling or redness around the eye.
• A severe and sometimes deadly complication called serotonin syndrome can occur. This risk may be increased if certain other drugs are taken at the same time. Call your doctor right away if you experience agitation, balance problems, confusion, hallucinations, high fever, tachycardia or abnormal heart rhythms, flushing, muscle twitching or stiffness, seizures, tremors or tremors, excessive sweating, severe diarrhea, nausea or vomiting , a very severe headache.

What are some other side effects of this drug?

Any medicine can have side effects. However, for many people, side effects are either minor or non-existent. Contact your doctor or seek medical attention if these or any other side effects bother you or do not go away:

• Feeling dizzy, drowsy, tired or weak.
• Nausea.
• Diarrhea or constipation.
• Dry mouth.
• Sleep disorders.
• Excessive sweating.
• Flu-like symptoms.
• Runny nose.
• Headache.
• Yawn.

This list of possible side effects is not exhaustive. If you have any questions about side effects, please contact your doctor. Talk to your doctor about side effects.

You can report side effects to the National Health Board.

You can report side effects to the FDA at 1-800-332-1088. You can also report side effects at https://www.fda.gov/medwatch.

What is the best way to take this drug?

Use this drug as directed by your doctor. Read all the information provided to you. Strictly follow all instructions.

All forms:

• Take this drug with or without food.
• Keep taking this drug as instructed by your doctor or other health care professional, even if you feel well.

Oral solution:

• Liquid doses should be measured with caution. Use the dispenser that comes with the medicine. If the dispenser is not provided in the package, ask the pharmacist for a dosing agent for this drug.

What should I do if I miss a dose of a drug?

• Take the missed dose as soon as you can.
• If it’s time to take your next dose, don’t take the missed dose and then go back to your regular dosing schedule.
• Do not take 2 doses or an additional dose at the same time.

How do I store and/or discard this drug?

• Store at room temperature in a dry place. Do not store in the bathroom.
• Keep all medicines in a safe place. Keep all medicines out of the reach of children and pets.
• Dispose of unused or expired drugs. Do not empty into a toilet or sewer unless instructed to do so. If you have any questions about disposing of medicines, ask your pharmacist. Drug disposal programs may be in place in your area.

General drug information

• If your health does not improve or even worsens, see your doctor.
• Do not give your medicine to anyone and do not take other people’s medicines.
• Some medicines may come with other patient information leaflets. If you have questions about this drug, talk with your doctor, nurse, pharmacist, or other health care professional.
• A separate instruction for patients is attached to the drug. Please read this information carefully. Reread it each time you refill your supply. If you have any questions about this drug, ask your doctor, pharmacist, or other health care professional.
• If you think you have overdosed, call a poison control center or get medical help right away. Be prepared to tell or show what drug you took, how much, and when it happened.

Consumer Use of Information and Limitation of Liability

This summary information includes summaries of diagnosis, treatment and/or drug product. It is not intended to be a comprehensive source of data and should be used as a tool to help the user understand and/or evaluate potential diagnostic and treatment options.