Uses, Side Effects, Dosages, Precautions

Lexapro is the trademark name for the generic drug escitalopram, which is a type of antidepressant medication. It belongs to a group of antidepressants called selective serotonin reuptake inhibitors (SSRI) that were first introduced in the 1980s. These medications are generally effective and have fewer side effects than some of the older antidepressants such as monoamine oxidase inhibitors (MAOIs). Lexapro, which comes in pill or liquid form, is used today to treat a variety of mental health conditions.

Verywell / JR Bee

Uses

It is not known exactly how Lexapro works to reduce symptoms of depression and anxiety. However, we know that this medication has an effect on serotonin, which is a brain neurotransmitter involved in mood, sleep, and other bodily functions.

It is thought that by taking Lexapro, serotonin levels in the brain become more balanced. This helps to reduce anxiety and enhance mood. Lexapro was initially used only to treat depression. However, research showed that it was also effective for other mood disorders as well as anxiety disorders.

While it is currently only approved by the Food and Drug Administration (FDA) for the treatment of depression and generalized anxiety disorder (GAD), it is prescribed for many other conditions.

Off-Label Uses

Doctors sometimes prescribe Lexapro off-label for the following:

Before Taking

Lexapro is prescribed for the treatment of anxiety disorder, depressive disorders, and other mood disorders, sometimes in combination with other medications. However, there are a number of steps involved in obtaining a prescription. Generally, a diagnosis of a mental health disorder must be given before you would be prescribed Lexapro.

While a primary care physician is capable of writing a prescription, the process may be better handled by a mental health professional, such as a psychiatrist, who can also prescribe medication.

Prior to starting the medication, tell your doctor if you are allergic or hypersensitive to escitalopram or are pregnant or breastfeeding. It’s also important to alert your doctor if you have a history of any of the following medical conditions, which may be exacerbated by Lexapro:

Talk to your doctor about all medications, supplements, and vitamins that you currently take. While some drugs pose minor interaction risks, others may outright contraindicate use or prompt careful consideration as to whether the pros of treatment outweigh the cons in your case.

Precautions and Contradictions

There are many precautions involved when taking Lexapro. You can reduce potential risks by being aware of who should not take this medication, potential medication interactions, and the black box warning.

Lexapro is not safe for everyone. Certain people should not take Lexapro or take with caution, including:

• People with allergies: You should not take Lexapro if you’re hypersensitive to escitalopram oxalate, meaning that you have a known allergy to the medication and experience symptoms of allergic reaction, such as difficulty breathing or swelling of the face, mouth, or tongue.
• Children: The effectiveness of Lexapro in children younger than 18 years of age has not been established, and it’s not generally recommended for kids under the age of 12.
• People who are pregnant or breastfeeding: Use Lexapro with caution if you’re pregnant or breastfeeding as the medication can be passed to your child. Your doctor should discuss this with you; if not, be sure to ask about potential risks.
• Older adults: The side effects of the medication can be more severe in older adults. In this case, your doctor should monitor your dose and adjust as necessary to reduce the severity of side effects.
• People who are taking blood thinners: Taking NSAIDs, aspirin, and warfarin can increase the risk of bleeding in people taking Lexapro.
• People who are taking serotonergic medications: Taking Lexapro with other serotonergic drugs as well as St. John’s wort can increase the risk of serotonin syndrome.

According to a black box warning (the strictest warning for prescription drugs issued by the FDA), taking Lexapro can result in an increased risk of suicidal thoughts and behaviors, particularly in children, adolescents, and young adults. Close monitoring by your psychiatrist or doctor is important particularly if you are an adolescent or young adult taking Lexapro.

If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 1-800-273-8255 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

Other SSRIs

Lexapro is an allosteric serotonin reuptake inhibitor, which differentiates it from other SSRIs. It is generally well-tolerated and effective.

Other commonly-prescribed FDA-approved SSRIs that treat issues similar to Lexapro include:

Dosage

The tablets are available in 5 milligram (mg), 10 mg, and 20 mg strengths. The 10 and 20 mg tablets are scored and can be cut in half. The oral solution comes in a strength of 1 mg per milliliter (mL).

The usual recommended daily dosage of Lexapro is 10 mg, but you may begin at a lower dose and increased slowly if needed.

The manufacturer recommended dose of Lexapro:

• Major depressive disorder over age 18: 10 mg per day and increased to 20 mg per day after three weeks if necessary
• Major depressive disorder age 12 to 18: 10 mg per day and increased to 20 mg per day after one week if necessary
• Generalized anxiety disorder: 10 mg per day

If you are experiencing the first episode of depression or anxiety, you may take Lexapro for a defined period such as between six months and one year. However, for individuals experiencing a chronic mental health condition, it may be necessary to take Lexapro for an extended period over many years.

All listed dosages are according to the drug manufacturer. Check your prescription and talk to your doctor to make sure you are taking the right dose for you.

Modifications

While there are not specific modified dose recommendations for Lexapro, the medication should be take with caution if you are elderly or have a major medical illness that affects your metabolism, such as kidney or liver disease. If this is the case, your health care provider may adjust your dose as necessary to reduce any related side effects.

How to Take and Store

Follow your doctor’s instructions for taking Lexapro. Ask your doctor or pharmacist if you have any questions about this medication.

• Lexapro is typically taken as a tablet or oral solution once daily, in the morning or evening, with or without food.
• Missed doses should be taken as soon as you remember unless it is very close to your next dose, in which case you should take your regular dose instead. Never take two or more doses of Lexapro together at the same time.
• Doses higher than 20 mg are not approved by the FDA. Staying within the recommended dose helps to reduce the risk of side effects or adverse reactions.
• Lexapro should be stored at room temperature, away from light and moisture. Do not store in the bathroom.
• If you’re traveling with Lexapro, be sure to carry your medication in its original packaging in your carry-on luggage and have your prescription with you.

It’s important to recognize that you will not experience immediate relief from taking Lexapro. It can take anywhere from one to four weeks to feel better once you start taking Lexapro, and you may not experience the full benefits of the medication until you’ve been following a recommended treatment plan for a couple of months.

Taking your medication as prescribed will ensure that you experience its full effectiveness.

Side Effects

As your body adjusts to taking the medication, the side effects should gradually go away. If you notice that they are getting worse or are interfering with your quality of life, talk to your doctor about your concerns.

Side effects can be minimized by carefully following the dosage directions given by your doctor and reporting any negative effects.

Common

The most common side effects are:

• Sleep disturbances
• Nausea
• Headaches
• Blurred vision
• Dry mouth
• Diarrhea
• Stomach pain
• Constipation
• Heartburn
• Lightheaded and faintness
• Irritability and nervousness
• Dizziness
• Changes in weight and appetite
• Fatigue
• Excessive sweating
• Flu-like symptoms
• Sexual side effects

Severe

Seek immediate help if you experience any of the following unusual side effects of Lexapro:

• Difficulty breathing or swallowing
• Swelling of the face, mouth, or tongue
• Fever
• Stiff muscles
• Fast heartbeat
• Vomiting
• Seizures
• Rash
• Confusion
• Hallucinations
• Suicidal thoughts or behaviors

Warnings and Interactions

Caution should be used when taking Lexapro along with other medications. To help avoid any possible drug interactions, let your doctor know about any other prescription and over-the-counter medications you are currently taking.

When taking Lexapro, the following serotonergic medications should not be used or only be used with significant caution and close monitoring due to the increased risk of serotonin syndrome:

• Other SSRIs such as Celexa (citalopram)
• Monoamine oxidase inhibitors (MAOIs), which are used to treat psychiatric disorders
• Tricyclic antidepressants such as Pamelor (nortriptyline)
• Triptans used for treating migraines such as sumatriptan
• St. John’s Wort

Avoid drinking alcohol when you are taking Lexapro, as it can reduce the effectiveness of the medication and also may increase its toxicity.

If Lexapro is not effective for you, your doctor will work to find another medication that may help, such as another SSRI or a different class of antidepressant medication. You may also find psychotherapy helpful if that has not already been implemented.

You should only discontinue taking Lexapro under the guidance of your doctor at an appropriate time (such as when symptoms have been stable for a certain period). Your doctor will help you to taper off the medication, so as to minimize any withdrawal effects.

If you stop taking it suddenly, you may notice withdrawal symptoms, including:

• Dizziness
• Muscle tension 
• Chills
• Confusion
• Trouble concentrating
• Trouble remembering things
• Crying

A Word From Verywell

This overview of the use of Lexapro for mental health conditions does not cover every possible outcome of taking this medication. If you have been prescribed this medication by your doctor, be sure to follow the instructions carefully. If you have additional questions, they are best answered by a medical professional.

Lexapro (Escitalopram) | Selective Serotonin Reuptake Inhibitors

Lexapro (escitalopram) is a selective serotonin reuptake inhibitor (SSRI) antidepressant medication. It is commonly used to treat anxiety in adults, depression in adults and adolescents who are at least 12 years old, tension, and excessive worry. It works by primarily increasing the amount of the neurotransmitter serotonin. It does this by preventing its reuptake into the presynaptic cell membrane. This SSRI drug is available by a doctor or psychiatrist’s prescription only.

Dosage FAQs

• How can I get the best results from treatment with this drug?
  Many conditions for which Lexapro is prescribed also show positive results from treatment with psychotherapy. Medication may dull the debilitating symptoms of anxiety and depression, but medication does not teach a person healthy ways to cope when symptoms, emotions, or behaviors arise or become triggered by mental health conditions. If you are prescribed an SSRI antidepressant, consider finding a qualified therapist or counselor to learn more about what you are experiencing and help you discover healthy ways to improve the quality of your life. Additionally, many people experiencing anxiety and depression have reported positive results from exercises like yoga, meditation, and breathwork activities. Many therapists offer specialized training in these mental health treatments that may reduce stress, anxiety, and symptoms of depression.
   
• How should I take this medication?
  Lexapro may be prescribed as a tablet or in liquid form. It is usually taken once per day, with or without food. For best results, take this medication at the same time each day. Your doctor may gradually increase the amount of medication you take in order to find the best dosage for you. It could take about 30 days to feel the full effects of this medication. Keep taking this medication as directed by your doctor, even if you begin to feel well. Do not let others take your medication even if they have similar symptoms. This drug is not approved for children under the age of 12.
   
• What should I do if I forget to take my medication?
  Take the medication you missed as soon as you remember it. If you are close to the time for your next dose, then do not take the dose you missed. Simply maintain your regular medication schedule. Taking too much of this SSRI too quickly may contribute to an overdose.
   
• What should I do if I overdose on this medication?
  Seek urgent medical attention or call a poison control center as soon as possible. Signs of overdose include sweating, drowsiness, fast heartbeat, seizures, nausea, or loss of consciousness.
   
• What is the best way to store this medication?
  Do not store this medication in your bathroom or kitchen. Keep this medication tightly closed in its original container at room temperature. Avoid exposing the container to excess heat or moisture. Keep this drug out of the reach of children.
   
• Are there any interactions with other medications I should know about?
  Lexapro may interact negatively with some medications and supplements, including monoamine oxidase inhibitors (MAOI), aspirin, anti-inflammatory drugs such as ibuprofen (Motrin) and naproxen (Aleve), migraine treatments, anticoagulants, antihistamines, antidepressants, antacids, anxiolytics, drugs for sleep issues, typical and atypical antipsychotics, blood pressure medications, vitamins, minerals, herbal products (particularly the herb St. John’s wort), products containing tryptophan, and more. Do not take this medication with other SSRI medications, especially Celexa.

Considerations Before Use

Antidepressant medications, including Lexapro, may cause intense suicidal feelings or suicidal behavior in children, adolescents, and young adults less than 24 years of age. Ask your doctor if using this medication outweighs the risks.

This medication may cause angle-closure glaucoma—an eye condition which may lead to blindness. It is recommended that you undergo a thorough eye examination before you take this medication.

It is important to discuss your entire health history with your doctor before taking Lexapro. Inform your doctor if you have had a heart attack, liver, kidney or heart disease, thyroid problems, seizures, or diabetes. Mention any reactions you may have had to other drugs. Ask your healthcare provider about alternative treatments if you become pregnant while prescribed this medication.

Do not purchase this medication outside of the United States or on the internet. Medication purchased from these sources may not be from a licensed pharmacy. Haloperidol, a powerful antipsychotic medication with potentially dangerous side effects, has been found in some samples of Lexapro obtained via the internet.

Warnings During Use

If you start to take this medication, here are some important points to keep in mind:

• This medication may cause withdrawal effects, lung condition, heart malformations, and other major defects in newborn babies if taken during pregnancy. According to the results of one study, women who take SSRIs during pregnancy may be more likely to have pre-term babies than women who do not take SSRIs and who do not have depression. Escitalopram, the major ingredient in Lexapro, may pass into breast milk and harm a nursing child. If you become pregnant you should not stop taking this medication unless advised to do so by your doctor.
• This drug may cause drowsiness. Do not drive, climb, or operate heavy equipment until you know what effect this medication has on you.
• Avoid using alcohol which taking this medication as it may worsen potential side effects.
• If you are scheduled for any type of surgery, tell your surgeon or anesthesiologist that you are being treated with Lexapro. This warning includes oral surgery.

Possible Side Effects

Contact your health care provider if you experience any of the following side effects. Serious side effects that may occur when taking Lexapro include:

• Irregular heartbeat
• Flu-like symptoms including fever
• Seizures
• Confusion
• Stiff muscles
• Visual or auditory hallucinations
• Increased excitement

Less serious side effects of this medication may include:

• Drowsiness
• Dry mouth
• Stomach or digestive issues
• Constipation or diarrhea
• Excessive sweating
• Noticeable changes in sex drive and/or ability
• Increase in appetite

How to Safely Withdraw

When it is time to reduce your dose of this medication, work with your doctor to facilitate the reduction. Never stop taking Lexapro abruptly. Slowly reducing this medication in your system may reduce the potential withdrawal symptoms. Possible symptoms of withdrawal include:

Talk with your doctor if you experience any withdrawal effects after stopping this medication.

References:

1. Citizens Commission on Human Rights International. (2012). The side effects of common psychiatric drugs. Retrieved from http://www.cchrint.org/pdfs/The_Side_Effects_of_Common_Psychiatric_Drugs.pdf
2. Drugs.com. (2014). Lexapro. Retrieved from http://www.drugs.com/lexapro.html
3. Medline Plus. (2014). Escitalopram. Retrieved from http://www.nlm.nih.gov/medlineplus/druginfo/meds/a603005.html
4. RxList. (2014). Lexapro. Retrieved from http://www.rxlist.com/lexapro-drug.htm

Page content reviewed by James Pendleton, ND.

Escitalopram (Lexapro): What It Is, How It Works, Uses & More

Medically reviewed by Kristin Hall, FNP Written by Our Editorial Team Last updated 7/19/2020

Escitalopram, commonly sold under the brand name Lexapro®, is a prescription antidepressant that’s used to treat depression, as well as a range of anxiety disorders. 

Escitalopram is part of a class of antidepressants called selective serotonin reuptake inhibitors, or SSRIs. These medications work by raising the concentration of certain neurotransmitters in the brain, particularly those responsible for regulating mood and mental health. 

If you’ve been diagnosed with depression or an anxiety condition such as generalized anxiety disorder (GAD), your healthcare provider may prescribe you escitalopram as a treatment.

Used correctly over the long term, escitalopram can be highly effective at treating depression and certain anxiety disorders. Like other antidepressants, it can cause a range of side effects that you should be aware of before using this medication.

Below, we’ve explained what escitalopram is, how it works and why it’s prescribed. We’ve also listed the potential side effects and interactions that can occur with escitalopram. Finally, we’ve answered some of the most frequently asked questions about this medication. 

What Is Escitalopram (Lexapro)?

Escitalopram is an antidepressant that belongs to the SSRI class of medications.

As an antidepressant, escitalopram is mostly commonly prescribed to treat depression. It’s also approved by the FDA for the treatment of generalized anxiety disorder. 

In some cases, healthcare professionals may also prescribe escitalopram off-label as a treatment for conditions such as social anxiety disorder (SAD), obsessive-compulsive disorder (OCD), panic disorder and premenstrual syndrome. 

Escitalopram was developed in the late 1990s and first approved in 2002 by the FDA. Over the years, it’s been widely prescribed to treat depression and anxiety disorders, with tens of millions of prescriptions every year in the U.S.

Compared to many older antidepressants, such as monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants (TCAs), SSRIs such as escitalopram tend to be safer and less likely to produce side effects or harmful drug interactions. 

In the United States, escitalopram is commonly sold under the brand name Lexapro. It’s also available as a generic medication under a variety of different names. 

How Escitalopram Works

Escitalopram works in the same way as other SSRIs, by inhibiting your brain’s reuptake of the neurotransmitter serotonin.

Serotonin is one of numerous important neurotransmitters used by the brain to transmit signals between neurons. It’s responsible for a diverse range of biological functions in the brain and in numerous other organs.

You may have heard of serotonin as the “feel good” neurotransmitter. This is because serotonin is responsible for, amongst other things, regulating your mood. 

Normal levels of serotonin are important for maintaining a stable mood. Serotonin also plays an important role in regulating your appetite and ability to sleep. 

People with depression often have low serotonin levels. By stopping your brain from absorbing serotonin after it’s released, SSRI medications like escitalopram increase the level of serotonin in your brain, helping to improve your mood and treat the symptoms of depression. 

online therapy

your own couch feels better, trust us

Escitalopram Dosages

Escitalopram comes in tablet and liquid oral solution form. In tablet form, it’s available in three different strengths: 5mg, 10mg and 20mg. For depression, escitalopram is normally prescribed at a dosage of 10mg to 20mg, taken one time per day.

For generalized anxiety disorder and other anxiety disorders, escitalopram is prescribed from 5mg to 20mg per day. 

Based on your symptoms and response to the medication, your healthcare provider may adjust your dosage of escitalopram over time. The maximum normal dosage of escitalopram for depression is 20mg per day. 

Escitalopram Side Effects and Interactions

Escitalopram may cause a range of potential side effects. These side effects are common to all SSRI. Most of the side effects of escitalopram are minor and temporary, although there are also several rare, potentially serious side effects that you should be aware of.

Common side effects of escitalopram include:

• Dry mouth
• Increased sweating
• Dizziness
• Nausea
• Diarrhea
• Constipation
• Indigestion
• Abdominal pain
• Flu-like symptoms
• Fatigue
• Insomnia
• Somnolescence (drowsiness)
• Reduced appetite
• Decreased libido (reduced interest in sex)
• Rhinitis and sinusitis

Of these side effects, the most common are nausea, insomnia, fatigue and decreased libido. In many cases, these side effects are transient and improve over several weeks as your body gets used to the medication. 

Escitalopram may cause sexual side effects. In women, the most common sexual side effect is anorgasmia (difficulty achieving orgasm). In clinical trials of escitalopram for depression, about two percent of users reported experiencing this side effect. 

In men, escitalopram may cause ejaculation disorder (affecting nine percent of users in clinical trials) and impotence (three percent of users). 

Some people prescribed escitalopram for anxiety may experience anxiety symptoms after starting this medication. Like other side effects, this is usually a temporary issue that gets better over the course of several weeks as your body adjusts to the medication.

If you experience persistent anxiety, or any other side effects, after you start using escitalopram, contact your healthcare provider for assistance. 

Although uncommon, escitalopram can potentially cause serious side effects. We’ve listed these and provided more information in our full guide to the side effects of escitalopram. 

FDA “Black Box” Warning: Suicidal Thoughts and/or Behavior

All antidepressants, including escitalopram, carry a “black box” warning from the FDA that lists potentially serious side effects and provides important safety information about the medication. 

This warning states that antidepressant medications are associated with an increased risk for suicidal thoughts and/or behavior in children and/or young people. For many antidepressants, this risk is highest during the first few weeks and months of treatment.

If you’re prescribed escitalopram or any other type of antidepressant and experience a change in your thoughts, mood, feelings or behavior, contact your healthcare provider or healthcare professional as soon as possible for assistance. 

Interactions Between Escitalopram and Other Medications

Escitalopram can interact with other medications, including both over-the-counter medications and prescription drugs. It’s also possible for escitalopram to interact with certain supplements, herbal products and vitamins.

Potentially serious interactions can occur if you take escitalopram with, or shortly after using, a range of other antidepressants.

If you currently use or have used a monoamine oxidase inhibitor (MAOI) in the last 14 days, you must inform your healthcare provider of this before discussing escitalopram. 

MAOIs can cause severe interactions when used within escitalopram, including serious health conditions such as serotonin syndrome. Commonly prescribed MAOIs that could interact with escitalopram include phenelzine, isocarboxazid, tranylcypromine, selegiline and others. 

Other antidepressants, including other SSRIs, SNRIs and tricyclic antidepressants, can interact with escitalopram. Escitalopram can also interact with antipsychotic and antianxiety medications such as pimozide, benzodiazepines, gabapentin and sleep aids such as zolpidem. 

Other medications that increase serotonin, including opioid painkillers, triptans, anxiolytics such as buspirone, amino acids such as tryptophan, stimulants and even over-the-counter treatments for depression such as St. John’s wort can potentially interact with escitalopram.

Escitalopram may also interact with certain blood thinners, medications used to treat migraines, water pills and other medications. 

To avoid interactions, tell your healthcare provider about any and all medications, supplements, vitamins and other health products you use before discussing escitalopram. Pay close attention to the safety instructions provided with escitalopram regarding drug interactions. 

Escitalopram and Pregnancy

Escitalopram has a category C rating from the FDA. This means that animal studies have found that it may cause problems for unborn children, but that there is insufficient study data regarding its effects on a human fetus during pregnancy. 

If you’re prescribed escitalopram, contact your healthcare provider if you believe that you could be pregnant or if you’re planning to become pregnant.

Depending on your needs and overall health, your healthcare provider may recommend making changes to your use of escitalopram during pregnancy. 

If you’re breastfeeding, a small amount of escitalopram may pass into your breast milk. In most studies, the small amount of escitalopram that can be present in breast milk does not appear to cause any harmful effects for babies. 

Nevertheless, if you’re currently breastfeeding or plan to breastfeed your child and also use escitalopram, talk to your healthcare provider for expert advice. 

Learn More About Depression Medications

If you’ve been diagnosed with depression, your healthcare provider may recommend escitalopram or one of several other medications.

A diverse range of medications are used to treat depression, from SSRIs to other medications such as SNRIs, MAOIs, TCAs and more. 

Our guide to depression medications goes into more detail on how these classes of medication differ, as well as their unique advantages, side effects and other information that you should be aware of if you’re being treated for depression. 

Frequently Asked Questions About Escitalopram (Lexapro)

What Is Escitalopram (Lexapro) Used For?

Escitalopram (Lexapro) is used to treat depression. It’s also used to treat a range of anxiety disorders and other conditions, including social anxiety disorder (SAD), panic disorder and obsessive-compulsive disorder (OCD).

How Long Does It Take for Escitalopram (Lexapro) to Start Working?

Escitalopram can take several weeks to start working as a treatment for depression and anxiety disorders. You may not notice any improvements for several weeks. In some cases, it can take up to eight weeks for escitalopram to start working effectively. 

If you don’t experience any improvements after using escitalopram for several weeks, don’t stop taking the medication suddenly. 

Instead, talk to your healthcare provider. Depending on your symptoms, they may recommend adjusting your dosage of escitalopram or using a different medication. 

How and When Should You Take Escitalopram (Lexapro)?

You can take escitalopram at any time of day, morning or night. It’s best to take escitalopram at approximately the same time every day. You can take escitalopram after eating a meal or on an empty stomach.

Some people experience difficulty sleeping after they start using escitalopram. If you’re prone to insomnia, you may experience better results taking escitalopram in the morning. 

If you forget to take escitalopram and remember on the same day, take the late dose as soon as you remember. If you forget and only remember the next day, skip the missed dose and take the medication one time per day as normal. 

If you accidentally take too much escitalopram and experience symptoms such as an overly fast heart rate, vomiting, dizziness, seizures, sedation or shaking, call 911 for emergency assistance as soon as you can. 

How Should You Stop Taking Escitalopram (Lexapro)?

Like other SSRIs, escitalopram may potentially cause withdrawal side effects if you stop taking it suddenly. These can include agitation, irritability, anxiety, sleep difficulties, mood changes and a range of other effects.

If you want to stop using escitalopram, do not suddenly stop taking the medication without first talking to your healthcare provider. They will likely advise you to gradually taper down your dosage of escitalopram to reduce your risk of experiencing withdrawal side symptoms.

How Long Does Escitalopram (Lexapro) Stay in Your System?

Escitalopram has a half-life of 27 to 32 hours. If you’re prescribed escitalopram at a normal dose for treating depression or an anxiety disorder and stop taking it, it will take approximately seven to nine days to completely exit your body.

As mentioned above, you should not suddenly stop taking escitalopram or adjust your dosage of this medication without talking to your healthcare provider. 

telepsychiatry

it’s never been easier to talk to a psychiatry provider about treatments

Can Escitalopram (Lexapro) Cause Weight Gain?

In general, large-scale studies tend to show that long-term use of antidepressants is associated with weight gain. However, study data on escitalopram and weight changes is very limited, with no definitive studies showing that it does or doesn’t cause changes in weight. 

Some research, such as this small-scale study conducted in 2007, has found that escitalopram is effective in reducing weight in obese and overweight people with eating disorders. 

In general, escitalopram doesn’t appear to cause the dramatic changes in weight that can often occur with older antidepressants. However, more research is necessary to determine exactly what affect this medication may have on weight fluctuations. 

How Long Do the Side Effects of Escitalopram (Lexapro) Last?

Like other SSRI medications, escitalopram can cause a range of side effects, some of which are common during the first few weeks. 

A small percentage of people who use escitalopram experience nausea and headaches during the first few weeks of using the medication. Most of the time, these side effects will go away on their own over the course of several weeks as your body adjusts to the medication. 

If you have persistent side effects after starting escitalopram, or experience serious side effects from this medication, contact your healthcare provider. 

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

Why Was I Prescribed Lexapro? What Are the Side Effects?

Lexapro (escitalopram) is an antidepressant, or more specifically a selective serotonin reuptake inhibitor (SSRI) used to treat depression and anxiety. This works by restoring serotonin balances in the brain. Furthermore, this medication may improve your energy level and feelings of well-being, as well as decrease nervousness.

Use and Dosage

You should take Lexapro by mouth with or without food (but as instructed by your doctor) typically once daily, either in the morning or evening. The exact dosage will depend on a few factors: the medical condition being treated, your age, other medications you’re taking, and your initial response to treatment. It is important you tell your doctor about all of the products you use, whether they be prescription or nonprescription drugs, so he can safely administer Lexapro.

In order to avoid potential side effects, you may first be prescribed a low dose to see how your body reacts. Then, the dose may be gradually increased. Regardless, it is important you listen to and follow your doctor’s careful instructions, as increasing your dose or overusing this medication will not improve your condition any faster; it will, instead, increase your risk of experiencing harmful side effects. So, take this medication regularly and as prescribed, in order to get the most benefit from it and to prevent a higher risk of unwanted side effects.

It is essential that you continue taking Lexapro, even if you feel your condition or symptoms have improved or subsided, unless otherwise instructed by your health care practitioner. Doing so can worsen conditions, as well as worsen or induce symptoms such as headaches, mood swings, sleep changes, tiredness, and feelings related to electric shock. To prevent this from happening, simply have a conversation with your doctor who will then gradually reduce your dose. You should also consult your doctor any time you experience new or worsening symptoms of the medication.

Side Effects of Lexapro

As with many antidepressants, Lexapro may produce some unwanted side effects. These side effects, however, do not typically outweigh the benefits of the medication. And if they persist or worsen, a simple discussion with your doctor may lead to an easy solution. Still, it is important to be aware of possible mild, more serious, and severe effects that may result from the medication:

Mild Side Effects
• Drowsiness
• Nausea
• Dizziness
• Dry mouth
• Constipation
• Difficult sleeping
• Increased sweating

Serious Side Effects

• Changes in sexual ability
• Decreased interest in sex
• Easy bruising or bleeding

Severe Side Effects

• Fainting
• Fast/irregular heartbeat
• Seizures
• Vomit (that resembles coffee grounds)
• Black or bloody stools
• Eye pain, swelling, or redness
• Widened pupils
• Vision changes (e.g., blurred vision)

Patients very rarely experience serious or severe side effects. But if you do, you should tell your doctor right away and seek out medical treatment immediately if you experience any of the more severe effects. It is also possible (but rare) for Lexapro to increase serotonin and cause a very serious condition called serotonin syndrome/toxicity. This risk of developing this condition increases if you take other drugs that increase your serotonin levels. Therefore, it is important you tell your doctor about all of the drugs you take before being prescribed Lexapro.

You can also have a very serious allergic reaction to this drug—though it is rare, you should be aware of the symptoms, which include a rash, itching, swelling, difficulty breathing, and severe dizziness. And if you do experience any of these symptoms, you should seek medical help right away.

Before Taking Lexapro

It’s important you take precautionary measures anytime you’re considering a new medication. Before you start taking Ambien, you should first…

• Talk to your doctor about existing allergies, especially to escitalopram or citalopram, as this product may contain inactive ingredients that can cause allergic reactions or other issues.
• Discuss your medical history, especially if you have a personal or family history of bipolar or manic-depressive disorder, suicide attempts, liver disease, seizures, intestinal ulcers/bleeding, glaucoma, or hyponatremia.
• Consider your age, which may increase sensitivity to certain side effects. Children, for example, may be more sensitive to certain effects like loss of appetite and weight loss, while older adults may be more sensitive to hyponatremia, loss of coordination, or bleeding.
• Understand all of the drug’s effects and risks, as Lexapro can cause the aforementioned side effects and conditions, as well as another condition that affects heart rhythm—this particular condition can then (though rarely) cause a fast or irregular heartbeat and other severe symptoms that require immediate medical attention.

Explore the latest mental wellness tips and discussions, delivered straight to your inbox.

Taylor Bennett

Taylor Bennett is the Content Development Manager at Thriveworks. She devotes herself to distributing important information about mental health and wellbeing, writing mental health news and self-improvement tips daily. Taylor received her bachelor’s degree in multimedia journalism, with minors in professional writing and leadership from Virginia Tech. She is a co-author of Leaving Depression Behind: An Interactive, Choose Your Path Book and has published content on Thought Catalog, Odyssey, and The Traveling Parent.

Check out “Leaving Depression Behind: An Interactive, Choose Your Path Book” written by AJ Centore and Taylor Bennett.”

Start a Relationship with An Exceptional Counselor

• Skilled and caring professional counselors
• Accepting all major and most insurances
• High-touch customer service & premium benefits
• Same- or next-day appointments
• Ultra-flexible 23.5hr cancellations

Lexapro Tablets – NPS MedicineWise

What is in this leaflet

This leaflet contains answers to some common questions about LEXAPRO.

It does not contain all the information that is known about LEXAPRO. It does not take the place of talking to your doctor or pharmacist.

All medicines have risks and benefits. Your doctor has weighed the risk of you using this medicine against the benefits he/she expects it will have for you.

If you have any concerns about using this medicine, ask your doctor or pharmacist.

Keep this leaflet with the medicine.
You may need to read it again

What LEXAPRO is used for

LEXAPRO is used to treat depression.

It belongs to a group of medicines called selective serotonin reuptake inhibitors (SSRIs). They are thought to work by their actions on brain chemicals called amines which are involved in controlling mood.

Depression is longer lasting or more severe than the “low moods” everyone has from time to time due to the stress of everyday life. It is thought to be caused by a chemical imbalance in parts of the brain. This imbalance affects your whole body and can cause emotional and physical symptoms such as feeling low in spirit, loss of interest in activities, being unable to enjoy life, poor appetite or overeating, disturbed sleep, often waking up early, loss of sex drive, lack of energy and feeling guilty over nothing.

LEXAPRO corrects this chemical imbalance and may help relieve the symptoms of depression.

LEXAPRO may also be used to treat patients who may avoid and/or are fearful of social situations.

LEXAPRO may also be used to treat patients who have excessive anxiety and worry.

LEXAPRO may also be used to treat irrational fears or obsessional behaviour (obsessive-compulsive disorder). Obsessive-compulsive disorder involves having both obsessions and compulsions. Obsessions are unwanted thoughts that occur over and over again. Compulsions are the ongoing need to repeat certain actions as a result of these thoughts.

Your doctor, however, may prescribe it for another purpose.

Ask your doctor if you have any questions about why it has been prescribed for you.

This medicine is only available with a doctor’s prescription.

LEXAPRO is not addictive. However, if you suddenly stop taking it, you may get side effects.

Tell your doctor if you get any side effects after stopping LEXAPRO.

Before you take it

When you must not take it

Do not take LEXAPRO if you are allergic to it, to any medicine containing escitalopram, citalopram, or any of the ingredients listed at the end of this leaflet.
Symptoms of an allergic reaction may include shortness of breath, wheezing or difficulty breathing, swelling of the face, lips, tongue or other parts of the body, or rash, itching or hives on the skin.

Do not take LEXAPRO at the same time as the following other medicines:

• pimozide, a medicine used to treat mental disorders
• monoamine oxidase inhibitors (MAOIs), such as phenelzine, tranylcypromine and moclobemide which are also used for the treatment of depression.
• monoamine oxidase inhibitors such as linezolid which is an antibiotic and selegiline which is used in the treatment of Parkinson’s Disease
  One day must elapse after you have finished taking moclobemide before you start taking LEXAPRO. If you have taken any other MAOI you will need to wait 14 days. After stopping LEXAPRO you must allow 14 days before taking any MAOI including moclobemide.
  Taking LEXAPRO with MAOIs may cause a serious reaction with a sudden increase in body temperature, extremely high blood pressure and severe convulsions. Your doctor will know when it is safe to start LEXAPRO after the MAOI has been stopped.

Do not take it after the expiry date printed on the pack.
If you take it after the expiry date has passed, it may not work as well. The expiry date refers to the last day of the month.

Do not take it if the packaging is torn or shows signs of tampering

Before you start to take it

Tell your doctor if:

• you have allergies to any other substances such as foods, preservatives or dyes.
• you are pregnant or intend to become pregnant.
  
  Medicines like Lexapro have been shown to reduce the quality of sperm in animal studies, which theoretically could affect fertility. If you are intending to start a family, ask your doctor for advice.
  Do not take LEXAPRO if you are pregnant unless you and your doctor have discussed the risks and benefits involved.
  Make sure your doctor and/or midwife know you are on LEXAPRO.
  When taken during pregnancy, particularly in the last three months of pregnancy, medicines like LEXAPRO may affect the general condition of your newborn baby and may increase the risk of a serious condition in babies, called persistent pulmonary hypertension of the newborn (PPHN), making the baby breathe faster and appear bluish. These symptoms usually begin during the first 24 hours after the baby is born. If this happens to your baby you should contact your doctor and/or midwife immediately.
  If used during pregnancy LEXAPRO should never be stopped abruptly.
• you are breast-feeding or planning to breast-feed.
  Do not take LEXAPRO if you are breast-feeding unless you and your doctor have discussed the risks and benefits involved. It is not recommended that you breast-feed while taking LEXAPRO as it is excreted in breast milk.
• you have, or have had, the following medical conditions:
  
  – a tendency to bleed or bruise easily
  – diabetes
  – heart disease
  – kidney disease
  – liver disease
  – bipolar disorder (manic depression)
  – a history of seizures or fits
  – restlessness and/or a need to move often
  – raised intraocular pressure (fluid pressure in the eye), or if you are at risk of angle-closure glaucoma.
• you are receiving electroconvulsive therapy.

Do not give LEXAPRO to a child or adolescent.
There is no experience with its use in children or adolescents under 18 years old.

LEXAPRO can be given to elderly patients over 65 years of age with a reduced dose.
The effects of LEXAPRO in elderly patients are similar to those in other patients.

If you have not told your doctor about any of the above, tell them before you use LEXAPRO.

Taking other medicines

Tell your doctor if you are taking any other medicines, including any that you buy without a prescription from your pharmacy, supermarket or health food shop.

Some medicines and LEXAPRO may interfere with each other. These include:

• bupropion, a medicine helping to treat nicotine dependence
• medicines used to treat reflux and ulcers, such as cimetidine, omeprazole, esomeprazole and lansoprazole
• medicines known to prolong bleeding, e.g. aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs)
• ticlopidine and warfarin, medicines used to prevent blood clots
• fluconazole, an anti-fungal medicine
• mefloquine, an anti-malaria medicine
• sumatriptan, used to treat migraines
• tramadol, used to relieve pain
• medicines affecting the chemicals in the brain
• some heart medications, e.g. flecainide, propafenone, metoprolol
• tryptophan, an amino-acid
• lithium, used to treat mood swings and some types of depression
• antipsychotics, a class of medicines used to treat certain mental and emotional conditions, e.g. risperidone, thioridazine and haloperidol
• tricyclic antidepressants, e.g. imipramine, desipramine
• St John’s Wort (Hypericum perforatum), a herbal remedy
• any other medicines for depression, anxiety, obsessive-compulsive disorder or pre-menstrual dysphoric disorder

These medicines may be affected by LEXAPRO, or may affect how well it works. You may need to use different amounts of your medicines, or take different medicines. Your doctor will advise you.

Some combinations of medicines may increase the risk of serious side effects and are potentially life threatening.

Your doctor or pharmacist has more information on medicines to be careful with or avoid while taking LEXAPRO.

How to take it

How much to take

Your doctor will decide what dose you will receive.

The standard dose for this medicine is 10 mg per day. This may be increased by your doctor to 20 mg per day.

The recommended maximum dose in elderly patients is 10 mg per day.

It is recommended that patients with liver disease receive an initial dose of 5 mg daily for the first two weeks. Your doctor may increase the dose to 10 mg daily.

Your doctor may have prescribed a different dose.

Ask your doctor or pharmacist if you are unsure of the correct dose for you.
They will tell you exactly how much to take.

Follow the instructions they give you.
If you take the wrong dose, LEXAPRO may not work as well and your condition may not improve.

How to take it

Swallow the tablets whole with a full glass of water.

Do not chew them.

When to take it

Take LEXAPRO as a single dose either in the morning or in the evening.

Take LEXAPRO with or without food.

How long to take it

Continue to take LEXAPRO even if it takes some time before you feel any improvement in your condition.
As with other medicines for the treatment of these conditions it may take a few weeks before you feel any improvement.

Individuals will vary greatly in their response to LEXAPRO. Your doctor will check your progress at regular intervals.

The duration of treatment may vary for each individual, but is usually at least 6 months.

In some cases the doctor may decide that longer treatment is necessary.

Continue taking your medicine for as long as your doctor tells you, even if you begin to feel better.
The underlying illness may persist for a long time and if you stop your treatment too soon, your symptoms may return.

Do not stop taking this medicine suddenly.
If LEXAPRO is stopped suddenly you may experience mild, but usually temporary, symptoms such as dizziness, pins and needles, electric shock sensations, sleep disturbances (vivid dreams, inability to sleep), feeling anxious or agitated, headaches, feeling sick (nausea), vomiting, sweating, tremor (shaking), feeling confused, feeling emotional or irritable, diarrhoea, visual disturbances, or fast or irregular heartbeats.

When you have completed your course of treatment, the dose of LEXAPRO is gradually reduced over a couple of weeks rather than stopped abruptly.

Your doctor will tell you how to reduce the dosage so that you do not get these unwanted effects.

If you forget to take it

If you miss a dose and remember in less than 12 hours, take it straight away, and then go back to taking it as you would normally.

Otherwise, if it is almost time for your next dose, skip the dose you missed and take the next dose when you are meant to.

Do not take a double dose to make up for the dose you have missed.

If you are not sure what to do, ask your doctor or pharmacist.

If you have trouble remembering when to take your medicine, ask your pharmacist for hints.

If you take too much (overdose)

Immediately telephone your doctor, or the Poisons Information Centre (Tel: 13 11 26), or go to Accident and Emergency at your nearest hospital, if you think you or anyone else may have taken too much LEXAPRO.

Do this even if there are no signs of discomfort or poisoning.

You may need urgent medical attention.

Symptoms of an overdose may include dizziness, low blood pressure, nausea (feeling sick), vomiting, agitation, tremor (shaking) and rarely convulsions and coma.

While you are taking it

Things you must do

If you are about to be started on any new medicine, remind your doctor and pharmacist that you are taking LEXAPRO.

Tell any other doctors, dentists and pharmacists who treat you that you are taking this medicine.

If you become pregnant while taking LEXAPRO, tell your doctor immediately.

Persons taking LEXAPRO may be more likely to think about killing themselves or actually trying to do so, especially when LEXAPRO is first started or the dose is changed. Tell your doctor immediately if you have thoughts about killing yourself or if you are close to or care for someone using LEXAPRO who talks about or shows signs of killing him or herself.
All mentions of suicide or violence must be taken seriously.

Occasionally, the symptoms of depression may include thoughts of suicide or self-harm. It is possible that these symptoms continue or get worse until the full antidepressant effect of the medicine becomes apparent. This is more likely to occur if you are a young adult, i.e. 18 to 24 years of age, and you have not used antidepressant medicines before.

Patients and care givers should pay attention for any of the following warning signs of suicide-related behaviour while taking LEXAPRO. Tell your doctor immediately, or even go to the nearest hospital for treatment:

• thoughts or talk of death or suicide
• thoughts or talk of self-harm or harm to others
• any recent attempts of self-harm
• increase in aggressive behaviour, irritability or agitation

Do not stop taking this medicine or change the dose without consulting your doctor, even if you experience increased anxiety at the beginning of treatment.
At the beginning of treatment, some patients may experience increased anxiety which will disappear during continued treatment.

Tell your doctor immediately if you experience symptoms such as restlessness or difficulty in sitting or standing still.
These symptoms can occur during the first weeks of treatment.

Contact your doctor as soon as possible if you suddenly experience an episode of mania.
Some patients with bipolar disorder (manic depression) may enter into a manic phase. This is characterised by profuse and rapidly changing ideas, exaggerated gaiety and excessive physical activity.

Sometimes you may be unaware of the above-mentioned symptoms and therefore you may find it helpful to ask a friend or relative to help you to observe the possible signs of change in your behaviour.

Things you must not do

Do not give the tablets to anyone else, even if they have the same condition as you.

Do not take LEXAPRO to treat any other complaints unless your doctor tells you to.

Do not stop taking LEXAPRO, or lower the dosage, without checking with your doctor.

Do not let yourself run out of medicine over the weekend or on holidays.
Suddenly stopping LEXAPRO may cause unwanted discontinuation symptoms such as dizziness, sensory disturbances, sleep disturbances, agitation or anxiety tremor, confusion, sweating, headache, diarrhoea, palpitations, emotional instability, irritability, visual disturbances and nausea. Your doctor will tell you when and how LEXAPRO should be discontinued. Your doctor will gradually reduce the amount you are using, usually over a period of one to two weeks, before stopping completely.

Things to be careful of

Be careful driving or operating machinery until you know how LEXAPRO affects you.
It may cause visual disturbance (such as blurred vision), nausea, fatigue and dizziness in some people, especially early in the treatment. If you have any of these symptoms, do not drive, operate machinery, or do anything else that could be dangerous.

Avoid alcohol while you are taking this medicine.
It is not advisable to drink alcohol while you are being treated for depression.

Side effects

All medicines may have some unwanted side effects. Sometimes they are serious, but most of the time they are not. Your doctor has weighed the risks of using this medicine against the benefits he/she expects it will have for you.

Tell your doctor or pharmacist as soon as possible if you do not feel well while you are taking LEXAPRO.
It helps most people with depression, social anxiety disorder (social phobia), generalised anxiety disorder and obsessive-compulsive disorder, but it may have unwanted side effects in a few people.

The side effects of LEXAPRO are, in general, mild and disappear after a short period of time.

Tell your doctor if you notice any of the following and they worry you:

• decreased appetite or loss of appetite
• dry mouth
• diarrhoea
• nausea (feeling sick)
• sleeplessness
• fatigue, sleepiness or drowsiness, yawning
• increased sweating
• sexual disturbances (decreased sexual drive; problems with ejaculation or erection; women may experience difficulties achieving orgasm)

*The side effects marked with an asterisk (*) are a number of rare side effects that are known to occur with medicines that work in a similar way to LEXAPRO.

Tell your doctor as soon as possible if you notice any of the following:

• agitation, confusion, panic attacks*, anxiety, restlessness*
• dizziness
• dizziness when you stand up due to low blood pressure*
• fast heart rate or decrease in heart rate or irregular heart beat
• low sodium levels in the blood (the symptoms are feeling sick and unwell with weak muscles or feeling confused)*
• abnormal liver function tests (increased amounts of liver enzymes in the blood)*
• difficulties urinating*
• unusual secretion of breast milk*
• bleeding disorders including skin and mucous bleeding (e.g. bruising*) and a low level of blood platelets*
• rash, itching, patches of circumscribed swellings
• an increased risk of bone fractures has been observed in patients taking this type of medicine*

These may be serious side effects of LEXAPRO. You may need urgent medical attention.

Tell your doctor immediately, or go to Accident and Emergency at your nearest hospital, if you notice any of the following:

• thoughts of harming yourself or thoughts of suicide*, see also section “Things you must do”
• serious allergic reaction
  (symptoms of an allergic reaction may include swelling of the face, lips, mouth or throat which may cause difficulty in swallowing or breathing, or hives)
• high fever, agitation, confusion, trembling and abrupt contractions of muscles
  (these symptoms may be signs of a rare condition called serotonin syndrome) *
• mania (i.e.: elevated mood and associated symptoms) *
• hallucinations
• seizures, tremors, movement disorders (involuntary movements of the muscles) *
• fast, irregular heart beat with feelings of dizziness or difficulty breathing

These are very serious side effects. You may need urgent medical attention or hospitalisation.

Tell your doctor if you notice anything else that is making you feel unwell.

Other side effects not listed above may occur in some people.

Do not be alarmed by this list of possible side effects.
You may not experience any of them.

After taking it

Storage

Keep LEXAPRO tablets in the blister pack until it is time to take them.
If you take the tablets out of the box or the blister pack, they may not keep well.

Keep LEXAPRO tablets in a cool dry place where the temperature stays below 30°C.

Do not store it or any other medicine in the bathroom, near a sink, or on a window-sill.

Do not leave it in the car.
Heat and damp can destroy some medicines.

Keep it where children cannot reach it.
A locked cupboard at least one-and-a-half metres above the ground is a good place to store medicines.

Disposal

If your doctor tells you to stop taking LEXAPRO, or the medicine has passed its expiry date, ask your pharmacist what to do with any that is left over.

Return any unused medicine to your pharmacist.

Product description

What it looks like

LEXAPRO comes in two types of tablets:

• LEXAPRO 10 mg film-coated tablets – oval, white, scored and marked with “E” and “L” on each side of the score on one side of the tablet.
• LEXAPRO 20 mg film-coated tablets – oval, white, scored and marked with “E” and “N” on each side of the score on one side of the tablet.

A box contains 28 tablets.

Ingredients

Active ingredient(s):

• LEXAPRO 10 mg tablets –
• 10 mg escitalopram (as oxalate) per tablet
• LEXAPRO 20 mg tablets –
• 20 mg escitalopram (as oxalate) per tablet

Inactive ingredients:

• microcrystalline cellulose
• croscarmellose sodium
• opadry OY-S28849 PI (4748) (contains: hypromellose, macrogol 400, titanium dioxide).magnesium stearate
• colloidal anhydrous silica
• purified talc

LEXAPRO does not contain lactose, gluten, sucrose, tartrazine or any other azo dyes.

Manufacturer/Sponsor

LEXAPRO is made by H. Lundbeck A/S, Denmark.

Distributed in Australia by:

Lundbeck Australia Pty Ltd
Ground Floor, 1 Innovation Road
North Ryde NSW 2113
Ph: +61 2 8669 1000

This leaflet was prepared on
10-09-2020.

Australian Registration Numbers:

LEXAPRO tablets

10 mg – AUST R 92051

20 mg – AUST R 92053

“Lexapro” is the registered trade mark of H. Lundbeck A/S.

AU – 661201 – CMI

Published by MIMS November 2020

Initiating antidepressant therapy? Try these 2 drugs first

J Fam Pract. 2009 Jul; 58(7): 365–369.

, MD, MPP,, MD, and , MD, MPH

Gail Patrick

Department of Family Medicine, University of Chicago,

Gene Combs

Department of Family Medicine, University of Chicago,

Thomas Gavagan

Department of Family Medicine, University of Chicago,

John Hickner, MD, MSc, PURLS Editor

John Hickner,
Department of Family Medicine, Cleveland Clinic,

Gail Patrick,
Department of Family Medicine, University of Chicago,

Corresponding author.Copyright © 2009 The Family Physicians Inquiries NetworkThis article has been cited by other articles in PMC.

For most patients, sertraline and escitalopram are more effective and better tolerated than other antidepressants.

Practice changer

When you initiate antidepressant therapy for patients who have not been treated for depression previously, select either sertraline or escitalopram. A large meta-analysis found these medications to be superior to other “new-generation” antidepressants.¹

Strength of recommendation

A: Meta-analysis of 117 high-quality studies.

Cipriani A, Furukawa TA, Salanti G, et al. Comparative efficacy and acceptability of 12 new-generation antidepressants: a multiple-treatments meta-analysis. Lancet. 2009;373:746-758.

ILLUSTRATIVE CASE

Mrs. D is a 45-year-old patient whom you’ve treated for type 2 diabetes for several years. On her latest visit, she reports a loss of energy and difficulty sleeping and wonders if they could be related to the diabetes. As you explore further and question Mrs. D about these symptoms, she becomes tearful—and tells you she has episodes of sadness and no longer enjoys things the way she used to. Although she has no past history of depression, when you suggest that her symptoms may be an indication of depression, she readily agrees.

You discuss treatment options, including antidepressants and therapy. Mrs. D decides to try medication. But with so many antidepressants on the market, how do you determine which to choose?

Major depression is the fourth leading cause of disease globally, according to the World Health Organization.² Depression is common in the United States as well, and primary care physicians are often the ones who are diagnosing and treating it. In fact, the US Preventive Services Task Force recently expanded its recommendation that primary care providers screen adults for depression, to include adolescents ages 12 to 18 years.³ When depression is diagnosed, physicians must help patients decide on an initial treatment plan.

All antidepressants are

not equal

Options for initial treatment of unipolar major depression include psychotherapy and the use of an antidepressant. For mild and moderate depression, psychotherapy alone is as effective as medication. Combined psychotherapy and antidepressants are more effective than either treatment alone for all degrees of depression.⁴

The ideal medication for depression would be a drug with a high level of effectiveness and a low side-effect profile; until now, however, there has been little evidence to support 1 antidepressant over another. Previous meta-analyses have concluded that there are no significant differences in either efficacy or acceptability among the various second-generation antidepressants on the market.^5,6 Thus, physicians have historically made initial monotherapy treatment decisions based on side effects and cost.^7,8 The meta-analysis we report on here tells a different story, providing strong evidence that some antidepressants are more effective and better tolerated than others.

STUDY SUMMARY: Meta-analysis reveals 2 “best” drugs

Cipriani et al¹ conducted a systematic review and multiple-treatments meta-analysis of 117 prospective randomized controlled trials (RCTs). Taken together, the RCTs evaluated the comparative efficacy and acceptability of 12 second-generation antidepressants: bupropion, citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, milnacipran, mirtazapine, paroxetine, reboxetine, sertraline, and venlafaxine. The methodology of this meta-analysis differed from that of traditional meta-analyses by allowing the integration of data from both direct and indirect comparisons. (An indirect comparison is one in which drugs from different trials are assessed by combining the results of their effectiveness and comparing the combined finding with the effectiveness of a drug that all the trials have in common.) Previous studies, based only on direct comparisons, yielded inconsistent results.

The studies included in this meta-analysis were all RCTs in which 1 of these 12 antidepressants was tested against 1, or several, other second-generation antidepressants as monotherapy for the acute treatment phase of unipolar major depression. The authors excluded placebo-controlled trials in order to evaluate efficacy and acceptability of the study medications relative to other commonly used antidepressants. They defined acute treatment as 8 weeks of antidepressant therapy, with a range of 6 to 12 weeks. The primary outcomes studied were response to treatment and dropout rate.

Response to treatment (efficacy) was constructed as a Yes or No variable; a positive response was defined as a reduction of ≥50% in symptom score on either the Hamilton depression rating scale or the Montgomery-Asberg rating scale, or a rating of “improved” or “very much improved” on the clinical global impression at 8 weeks. Efficacy was calculated on an intention-to-treat basis; if data were missing for a participant, that person was classified as a nonresponder.

Dropout rate was used to represent acceptability, as the authors believed it to be a more clinically meaningful measure than either side effects or symptom scores. Comparative efficacy and acceptability were analyzed. Fluoxetine—the first of the second-generation antidepressants—was used as the reference medication. The shows the outcomes for 9 of the antidepressants, compared with those of fluoxetine. The other 2 antidepressants, milnacipran and reboxetine, are omitted because they are not available in the United States.

Sertraline and escitalopram come out on top

Using fluoxetine as the reference medication, the researchers analyzed various second-generation antidepressants. Sertraline and escitalopram had the best combination of efficacy and acceptability.

OR, odds ratio.

Source: Cipriani A et al. Lancet. 2009.¹

The overall meta-analysis included 25,928 individuals, with 24,595 in the efficacy analysis and 24,693 in the acceptability analysis. Nearly two-thirds (64%) of the participants were women. The mean duration of follow-up was 8.1 weeks, and mean sample size per study was 110. Studies of women with postpartum depression were excluded.

Escitalopram and sertraline stand out. Overall, escitalopram, mirtazapine, sertraline, and venlafaxine were significantly more efficacious than fluoxetine or the other medications. Bupropion, citalopram, escitalopram, and sertraline were better tolerated than the other antidepressants. Escitalopram and sertraline were found to have the best combination of efficacy and acceptability.

Efficacy results. Fifty-nine percent of participants responded to sertraline, vs a 52% response rate for fluoxetine (number needed to treat [NNT]=14). Similarly, 52% of participants responded to escitalopram, compared with 47% of those taking fluoxetine (NNT=20).

Acceptability results. In terms of dropout rate, 28% of participants discontinued fluoxetine, vs 24% of patients taking sertraline. This means that 25 patients would need to be treated with sertraline, rather than fluoxetine, to avoid 1 discontinuation. In the comparison of fluoxetine vs escitalopram, 25% discontinued fluoxetine, compared with 24% who discontinued escitalopram.

The efficacy and acceptability of sertraline and escitalopram compared with other second-generation antidepressant medications show similar trends.

The generic advantage. The investigators recommend sertraline as the best choice for an initial antidepressant because it is available in generic form and is therefore lower in cost. They further recommend that sertraline, instead of fluoxetine or placebo, be the new standard against which other antidepressants are compared.

WHAT’S NEW?: Antidepressant choice is evidence-based

We now have solid evidence for choosing sertraline or escitalopram as the first medication to use when treating a patient with newly diagnosed depression. This represents a practice change because antidepressants that are less effective and less acceptable have been chosen more frequently than either of these medications. That conclusion is based on our analysis of the National Ambulatory Medical Care Survey database for outpatient and ambulatory clinic visits in 2005-2006 (the most recent data available). We conducted this analysis to determine which of the second-generation antidepressants were prescribed most for initial monotherapy of major depression.

FAST TRACK

Antidepressants that are less effective and less acceptable than sertraline or escitalopram have been prescribed with greater frequency.

Our finding: An estimated 4 million patients ages 18 years and older diagnosed with depression in the course of the study year received new prescriptions for a single antidepressant. Six medications accounted for 90% of the prescriptions, in the following order:

• fluoxetine (Prozac)

• duloxetine (Cymbalta)

• escitalopram (Lexapro)

• paroxetine (Paxil)

• venlafaxine (Effexor)

• sertraline (Zoloft).

Sertraline and escitalopram, the drugs shown to be most effective and acceptable in the Cipriani meta-analysis, accounted for 11.8% and 14.5% of the prescriptions, respectively.

CAVEATS: Meta-analysis looked only at acute treatment phase

The results of this study are limited to initial therapy as measured at 8 weeks. Little long-term outcome data are available; response to initial therapy may not be a predictor of full remission or long-term success. Current guidelines suggest maintenance of the initial successful therapy, often with increasing intervals between visits, to prevent relapse.⁹

FAST TRACK

Response in the acute phase of treatment for major depression may not be predictive of long-term outcomes.

This study does not add new insight into long-term response rates. Nor does it deal with choice of a replacement or second antidepressant for nonresponders or those who cannot tolerate the initial drug.

What’s more, the study covers drug treatment alone, which may not be the best initial treatment for depression. Psychotherapy, in the form of cognitive behavioral therapy or interpersonal therapy, when available, is equally effective, has fewer potential physiologic side effects, and may produce longer-lasting results.^10,11

Little is known about study design

The authors of this study had access only to limited information about inclusion criteria and the composition of initial study populations or settings. There is a difference between a trial designed to evaluate the “efficacy” of an intervention (“the beneficial and harmful effects of an intervention under controlled circumstances”) and the “effectiveness” of an intervention (the “beneficial and harmful effects of the intervention under usual circumstances”).¹² It is not clear which of the 117 studies were efficacy studies and which were effectiveness studies. This may limit the overall generalizability of the study results to a primary care population.

Studies included in this meta-analysis were selected exclusively from published literature. There is some evidence that there is a bias toward the publication of studies with positive results, which may have the effect of overstating the effectiveness of a given antidepressant.¹³ However, we have no reason to believe that this bias would favor any particular drug.

Most of the included studies were sponsored by drug companies. Notably, pharmaceutical companies have the option of continuing to conduct trials of medications until a study results in a positive finding for their medication, with no penalty for the suppression of equivocal or negative results (negative publication bias). Under current FDA guidelines, there is little transparency to the consumer as to how many trials have been undertaken and the direction of the results, published or unpublished.¹⁴

We doubt that either publication bias or the design and sponsorship of the studies included in this meta-analysis present significant threats to the validity of these findings over other sources upon which guidelines rely, given that these issues are common to much of the research on pharmacologic therapy. We also doubt that the compensation of the authors by pharmaceutical companies would bias the outcome of the study in this instance. One of the authors (TAF) received compensation from Pfizer, the maker of Zoloft, which is also available as generic sertraline. None of the authors received compensation from Forest Pharmaceuticals, the makers of Lexapro (escitalopram).

CHALLENGES TO IMPLEMENTATION: No major barriers are anticipated

Both sertraline and escitalopram are covered by most health insurers. As noted above, sertraline is available in generic formulation, and is therefore much less expensive than escitalopram. In a check of online drug prices, we found a prescription for a 3-month supply of Lexapro (10 mg) to cost about $250; a 3-month supply of generic sertraline (100 mg) from the same sources would cost approximately $35 (www.pharmcychecker.com). Both Pfizer, the maker of Zoloft, and Forest Pharmaceuticals, the maker of Lexapro, have patient assistance programs to make these medications available to low-income, uninsured patients.

Acknowledgments

The PURLs Surveillance System is supported in part by Grant Number UL1RR02499 from the National Center for Research Resources, a Clinical Translational Science Award to the University of Chicago. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Research Resources or the National Institutes of Health.

The authors wish to acknowledge Sofia Medvedev, PhD, of the University HealthSystem Consortium in Oak Brook, Ill, for analysis of the National Ambulatory Medical Care Survey data and the UHC Clinical Database.

PURLs methodology This study was selected and evaluated using FPIN’s Priority Updates from the Research Literature (PURL) Surveillance System methodology. The criteria and findings leading to the selection of this study as a PURL can be accessed at www.jfponline.com/purls.

Contributor Information

Gail Patrick,
Department of Family Medicine, University of Chicago,

Gene Combs,
Department of Family Medicine, University of Chicago,

Thomas Gavagan,
Department of Family Medicine, University of Chicago,

References

1. Cipriani A, Furukawa TA, Salanti G, et al. Comparative efficacy and acceptability of 12 new-generation antidepressants: a multiple-treatments meta-analysis. Lancet. 2009;373:746–758.. [PubMed] [Google Scholar]2. Murray CJ, Lopez AD. Global Burden of Disease. Cambridge, MA: Harvard University Press; 1996. [Google Scholar]3. Williams SB, O’Connor EA, Eder M, et al. Screening for child and adolescent depression in primary care settings: a systematic evidence review for the U.S. Preventive Services Task Force. Pediatrics. 2009;123:e716–e735.. [PubMed] [Google Scholar]5. Gartlehner G, Hansen RA, Thieda P, et al.
Comparative Effectiveness of Second-Generation Antidepressants in the Pharmacologic Treatment of Adult Depression. Comparative Effectiveness Review No. 7. (Prepared by RTI International-University of North Carolina Evidence Based Practice Center under Contract No. 290-02-0016.) Rockville, MD: Agency for Healthcare Research and Quality; January 2007. Available at: www.effectivehealthcare.ahrq.gov/reports/final.cfm. Accessed May 18, 2009. [Google Scholar]6. Hansen RA, Gartlehner G, Lohr KN, et al. Efficacy and safety of second-generation antidepressants in the treatment of major depressive disorder. Ann Intern Med. 2005;143:415–426.. [PubMed] [Google Scholar]7. Adams SM, Miller KE, Zylstra RG. Pharmacologic management of adult depression. Am Fam Physician. 2008;77:785–792.. [PubMed] [Google Scholar]8. Qaseem A, Snow V, Denberg TD, et al. Using second-generation antidepressants to treat depressive disorders: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2008;149:725–733.. [PubMed] [Google Scholar]9. DeRubeis RJ, Hollon SD, Amsterdam JD, et al. Cognitive therapy vs medications in the treatment of moderate to severe depression. Arch Gen Psychiatry. 2005;62:409–416.. [PubMed] [Google Scholar]10. deMello MF, de Jesus MJ, Bacaltchuk J, et al. A systematic review of research findings on the efficacy of interpersonal therapy for depressive disorders. Eur Arch Psychiatry Clin Neurosci. 2005;255:75–82.. [PubMed] [Google Scholar]12. Sackett D. An introduction to performing therapeutic trials. In: Haynes RB, Sackett DL, et al, eds. Clinical Epidemiology: How to Do Clinical Practice Research. 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2006. [Google Scholar]13. Turner EH, Matthews AM, Linardatos E, et al. Selective publication of antidepressant trials and its influence on apparent efficacy. N Engl J Med. 2008;358:252–260.. [PubMed] [Google Scholar]14. Mathew SJ, Charney DS. Publication bias and the efficacy of antidepressants. Am J Psychiatry. 2009;166:140–145.. [PubMed] [Google Scholar]

Lexapro (Escitalopram): Uses, Dosage & Side Effects

Lexapro (escitalopram) is a commonly prescribed medication for treating depression and anxiety. Nearly 26 million Americans take Lexapro to help improve their energy levels and well-being and feel less nervous.

What Is Lexapro?

Lexapro is a commonly prescribed antidepressant used to treat clinical depression and anxiety. These are not just feelings you can always ‘snap out’ of, and millions of Americans with these mental problems feel better with this medication. Lexapro belongs to a class of drugs called selective serotonin reuptake inhibitors or SSRIs. These types of medicines act on chemical messengers or neurotransmitters in the brain that may be unbalanced in people with depression or anxiety.

Get a mental health prescription for just $12

Get started

Lexapro Generic Name

Lexapro is a brand name for the generic drug called escitalopram oxalate or escitalopram for short. The Food and Drug Administration (FDA) approved the first generic version of Lexapro in 2012.

Escitalopram Uses

Escitalopram (Lexapro) has two main uses: to treat people who are at least 12 years old for major depressive disorder in the short-term (acute) or long-term (maintenance), and to treat adults who have generalized anxiety disorder.

According to the National Institute of Mental Health (NIMH), both of these disorders are common in America:

• Major depressive disorder (MDD): More than 7% of American adults have at least one major depressive episode a year, with more women than men reporting suffering from this disorder. Depression most often occurs in young adults aged 18-25 years old.
• Generalized anxiety disorder (GAD): Almost 6% of American adults have suffered from GAD at some point in their lifetime. What’s more, nearly one in three people with GAD struggle with severe anxiety and mental illness.

Lexapro and depression

Major depressive disorder, also called clinical depression, is a common and serious mood disorder where you have a persistent feeling of sadness and loss of interest, and you may feel as if life isn’t worth living. You lose interest in activities you once enjoyed and you are unable or find it hard to carry out your day-to-day tasks. Apart from these emotional problems, you may also have physical symptoms such as chronic pain or digestive issues.

According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, also known as the DSM-5, to be diagnosed with major depressive disorder, you will have at least five of the following symptoms where at least one of the symptoms is either a depressed mood or a loss of interest/pleasure. You will have have had these symptoms persistently nearly every day for at least two weeks:

• A depressed mood
• A loss of interest in your usual activities
• A significant change in appetite and/or weight
• A slowing-down of thought and a visible slowing-down of movements, and physical and emotional reactions (psychomotor retardation)
• Fatigue or loss of energy
• Feelings of excessive or inappropriate guilt or worthlessness
• Difficulty thinking and concentrating, or indecisiveness
• Suicidal thoughts, recurrent suicidal ideation, or a suicide plan or attempt

Lexapro and anxiety

Generalized anxiety disorder is where you have excessive anxiety and worry that is difficult to control. This anxiety and worry can be about various activities in your life, reducing your ability to cope with everyday tasks and causing you a lot of distress. GAD occurs on more days than not for at least six months.

According to the DSM-5, GAD is associated with at least three of the following symptoms:

• Restlessness or feeling keyed up or on edge
• Being easily fatigued
• Difficulty concentrating or your mind going blank
• Irritability
• Muscle aches or soreness
• Difficulty sleeping

Escitalopram may also be helpful for some people when their doctor prescribes it for “off-label” use. “Off-label” means that it hasn’t been approved by the FDA for other conditions. Escitalopram is sometimes prescribed off-label for conditions including obsessive compulsive disorder (OCD), panic disorder, and premenstrual dysphoric disorder. Your doctor should have justifiable, good reasons and be up-to-date on the medical research before prescribing escitalopram for these conditions.

How Does Escitalopram Work?

Escitalopram is a selective serotonin reuptake inhibitor or SSRI, which means it acts in the brain to prevent the reuptake or absorption of serotonin by neurons (brain nerve cells). This results in increased levels of serotonin in the brain because it is kept around for longer before being absorbed by neurons. Since serotonin is a chemical that helps to regulate your mood, this is how it is thought to relieve depression.

Before You Take Escitalopram

Escitalopram is not a medication that is ideal for everyone with MDD or GAD. You should not take it if you are aware of an allergy or hypersensitivity to escitalopram or citalopram (Celexa) or if you also take pimozide (Orap). Before you take escitalopram, your doctor will need to go through your medical history and check that you do not have any other health issues which would affect how well this medicine will work. For example, your doctor will not prescribe escitalopram if you have bipolar depression and the FDA recommends caution in prescribing escitalopram if you have a seizure disorder or bipolar mania.

Make sure your doctor knows if you have liver or kidney disease because this can affect how well your body can break down and eliminate escitalopram from your body. Your doctor should also be aware if you have heart disease, high blood pressure, or a bleeding or clotting disorder. Moreover, if you’re pregnant or nursing a baby, escitalopram should be avoided since there is a risk it could harm the fetus and it can be passed through breast milk to a newborn baby.

Escitalopram can potentially interact with numerous medications, increasing or decreasing its concentration in the blood or how well it works. Such escitalopram interactions can also cause preventable side-effects. It is very important that your doctor knows what other medications you are currently taking before prescribing escitalopram. You also need to make sure you notify your doctor if you start or stop taking over-the-counter (OTC) medications or off-the-counter supplements while on escitalopram.

Do not use escitalopram if you have taken a monoamine oxidase inhibitor (MAOI) in the last 14 days or are about to take an MAOI within the next 14 days because this can result in dangerously increased blood pressure and serotonin syndrome.

Other medications that can interact with escitalopram include:

Avoid drinking alcohol with escitalopram as this can cause unpleasant but preventable side effects. Escitalopram can impair your thinking and reactions so make sure while you are taking this medicine that you are especially careful while driving or carrying out other activities where you need to be alert.

Escitalopram Dosage

You will need to take escitalopram once a day by mouth as a tablet or liquid with or without food. Try to take the medicine at the same time each day. Your doctor will start you on a low dose and slowly increase it if needed.

Most people taking escitalopram will take it as a dose in the range of 10-20 mg.

For major depressive disorder:

• Adolescents 12-17 years old: Initial dose = 10 mg. If the dose is increased to 20 mg, this should happen after at least three weeks.
• Adults: Initial dose = 10 mg. If the dose is increased to 20 mg, this should occur after at least one week.

For generalized anxiety disorder:

• Adults: Initial dose = 10 mg. If the dose is increased to 20 mg, this should occur after at least one week.

If taking escitalopram as a liquid, make sure to measure it accurately with a dosing spoon or oral syringe. This should come with your medicine and if not, you can get it from your pharmacy.

Store your medicine at room temperature away from moisture and heat.

Get a mental health prescription for just $12

Get started

What happens if I miss a dose?

Always take your medication according to your doctor’s instructions and what it says on the information sheet that comes with your tablets. If you miss a dose, take it as soon as possible. However, if it is nearly time for your next dose, skip the missed dose and continue with your regular dosing schedule. Never double your dose to compensate for your missed dose.

How long does it take for escitalopram to take effect?

You will need to be patient when you first start taking escitalopram since it is slow acting and it can take up to four weeks before you feel any effects. You will need to make regular follow-up appointments with your doctor to make sure you are continuing on the best dosage for you.

Can you stop escitalopram cold turkey? Does escitalopram cause withdrawal symptoms?

Do not stop taking escitalopram, even if you feel better, without discussing it first with your doctor. If you and your doctor find that it is time to stop taking escitalopram, it is not a good idea to cease the medication suddenly. This is because you can end up with some unpleasant escitalopram withdrawal symptoms. These can include irritability, nausea, dizziness, vomiting, nightmares, headaches, and/or tingling prickly skin. Instead, discuss with your doctor how you can slower reduce your dose to avoid any unwanted withdrawal effects.

Common Side Effects

Common escitalopram side effects include but are not limited to:

• Dizziness, drowsiness, weakness
• Sweating, feeling shaky or anxious
• Sleep problems (insomnia)
• Dry mouth
• Nausea
• Constipation
• Yawning
• Decreased sex drive, impotence, or difficulty having an orgasm
• Weight gain

Lexapro and weight gain

You may gain a little bit of weight when taking escitalopram. Experts are not sure why this happens but it may be that SSRIs cause changes in your body’s metabolism so that you are not as efficiently using up the calories you take in through your food. It could also be because the drug increases your appetite.

Escitalopram Alternatives

Escitalopram is not for everyone who suffers from MDD or GAD. If for whatever reason escitalopram is not alleviating your anxiety and/or depression, or you cannot take escitalopram due to a pre-existing medical condition or medication that would interact with escitalopram, there are other treatments that may help you.

Talk with your doctor to see whether you can try other medications such as sertraline (Zoloft) and bupropion (Wellbutrin), or various therapies such as cognitive-behavioral therapy, psychotherapy, acceptance and commitment therapy (ACT), or other ‘talk therapies’. Many people suffering from depression and GAD find such therapies to be of great benefit.

Lexapro vs. Zoloft

Both escitalopram and Zoloft are SSRIs which means they work in the brain to combat depression and anxiety in a similar way. However, Zoloft is also FDA approved to treat obsessive compulsive disorder, panic disorder, and premenstrual dysphoric disorder (PMDD), while escitalopram is only used off-label for these conditions.

Concerning side effects, the two drugs have some side effects in common such as, drowsiness, nausea, feeling shaky, changes in appetite, headache, diarrhea, difficulty sleeping (insomnia), dry mouth, increased sweating, weight changes, sexual difficulties, and upset stomach/indigestion. However, Zoloft can also cause other side effects including nervousness, dizziness, skin rash, or constipation.

Zoloft is taken at a higher dosage than escitalopram. Namely, 25-200 mg once daily for all approved conditions except for PMDD which is at 50-150 mg daily. Both drugs have interactions with MAOIs and can cause unpleasant withdrawal symptoms if you stop taking them suddenly.

Lexapro vs. Wellbutrin

Wellbutrin and escitalopram are both antidepressants that are used to treat major depressive disorder. As we have discussed, escitalopram is also used to treat anxiety. Whereas Wellbutrin is also used to treat seasonal affective disorder (SAD). SAD is another mood disorder where people have depressive symptoms at only a particular time each year, most often during the winter. The two medicines belong to different drug classes; while escitalopram is an SSRI, Wellbutrin is an aminoketone. This means that Wellbutrin works in the brain to prevent the reuptake or absorption of dopamine and norepinephrine. By preventing their uptake, Wellbutrin increases their levels in the brain.

The two drugs have side effects in common and some different side effects. Both drugs interact with MAOIs. Wellbutrin should not be taken if you have a history of seizures.

Which antidepressant has the least side effects?

Each antidepressant can have different side effects and different people will react to antidepressants differently. It is always worth discussing possible major side effects with your doctor or pharmacist. Doctors usually start by prescribing an SSRI, such as escitalopram and Zoloft, because these medications tend to cause fewer side effects and are less likely to cause problems at higher therapeutic doses than other types of antidepressants. If your doctor thinks it is worth you trying Zoloft or Wellbutrin instead of starting or continuing on escitalopram, feel free to ask questions and discuss any concerns you have.

Get a mental health prescription for just $12

Get started

When to See a Doctor

Major depressive disorder

If you’ve been feeling down, depressed or hopeless and feeling for at least a couple of weeks little interest or pleasure in things you normally enjoy, it is time to see your primary-care doctor or a mental-health specialist for an evaluation. This is particularly important if you’ve also been having trouble sleeping or concentrating, notice changes in your appetite and energy, and have thoughts of death. If you have people in your family with clinical depression this may be a clue to some genetic cause of how you’re feeling.

At your first visit to the doctor or mental-health specialist, he or she will ask you about your feelings and symptoms, how long you’ve had them, and whether you’re changing or limiting your activities as a result. You may also be asked to answer a short questionnaire called the PHQ-9 which will further help your doctor determine whether you have depression and if yes, how severely you’re suffering from this condition. Depending on the type of depression you may have, your doctor may suggest psychotherapy and/or prescribe you medication. Normally you will be on such antidepressant medication for at least half a year. Be warned that stopping early can put you at a high risk of relapse. You will need regular follow up appointments with your doctor to check all is going as it should. Many people find psychotherapy is as effective as medication and it may be even more effective than medication in the long-term.

Your family and close friends should be aware you’re on medication so they can support you and also because some young people can have thoughts of suicide when first taking an antidepressant. If you notice mood changes or suicidal ideation, especially in the beginning of treatment, notify your doctor or seek medical attention right away.

Generalized anxiety disorder

If you are finding that your anxiety is giving you feelings of not being able to cope or feeling overwhelmed, that it is interfering with your daily life, or you have the feeling it is caused by an underlying mental health problem, it’s time to see your doctor. This is particularly important if you have suffered an anxiety attack with mental and physical symptoms such as:

• Feelings of danger, panic, or dread
• Nervousness or restlessness
• Rapid heart rate
• Sweating
• Trembling or chills
• Tiredness or weakness
• Gastrointestinal problems
• Difficulty focusing
• Hyperventilation

Your doctor may refer you to a mental health practitioner who will work with you to discuss your concerns, find ways of coping you may have not considered before, recommend a form of psychotherapy, and if needed, see if you can benefit from medication. Anxiety is not something that needs to take over your life. Seeking professional help can guide you to a treatment that works best for you. Once suitable treatment is found, you will feel much more in control and find life more enjoyable.

Severe side effects and overdosing

Be sure to immediately seek emergency medical assistance if you have signs of a rare allergic reaction to escitalopram. Look out for:

• Skin rash or hives
• Difficulty breathing
• Swelling of your face, lips, tongue, or throat

Also call your doctor straight away if you have any of the following serious side effects:

• Vision or eye problems: blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights
• Mental symptoms: racing thoughts, unusual risk-taking behavior, feelings of extreme happiness or sadness
• Signs of low salt levels: headache, confusion, slurred speech, severe weakness, vomiting, loss of coordination, feeling unsteady
• Severe nervous system reactions: very stiff (rigid) muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors, feeling like you might pass out
• Signs of serotonin syndrome: agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting, or diarrhea

If you suspect an overdose, seek emergency medical attention (by calling 911), or call the poison help line at 1-800-222-1222. Symptoms of overdose can include:

• Low blood pressure
• Insomnia
• Dizziness
• Sweating
• Nausea
• Vomiting
• Tremor
• Drowsiness

How K Health Can Help

Anxiety and depression are among the most under-reported and under-treated diseases in America. Nearly 20% of adults in the US suffer from mental health illness and fewer than half receive treatment. Our mission is to increase access to treatment for those suffering in silence.

You can start controlling your anxiety and depression and get access to the treatment you need with K Health. Starting at $12/month get prescriptions for mental health medications plus unlimited doctor visits through the K Health app. Start your free assessment to see if you’re eligible.

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.

Escitalopram: Pediatric Medication | Memorial Sloan Kettering Cancer Center

This document, provided by Lexicomp ^® , contains all the information you need to know about the drug, including the indications, route of administration, side effects and when you should contact your healthcare provider.

Trade names: USA

Lexapro

Trade names: Canada

ACH-Escitalopram; ACT Escitalopram ODT; ACT Escitalopram [DSC]; AG-Escitalopram; APO-Escitalopram; Auro-Escitalopram; BIO-Escitalopram; Cipralex; Cipralex Meltz [DSC]; JAMP-Escitalopram; KYE-Escitalopram; M-Escitalopram; Mar-Escitalopram; MINT-Escitalopram; MYLAN-Escitalopram; NAT-Escitalopram; NRA-Escitalopram; PMS-Escitalopram; Priva-Escitalopram; RAN-Escitalopram; RIVA-Escitalopram; SANDOZ Escitalopram; TEVA-Escitalopram

Warning

• 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 attempted suicide or have had suicidal thoughts in the past. All people taking this drug must be closely monitored. Call your doctor right away if you have signs such as depressed mood (depression), nervousness, anxiety, grumpiness, or anxiety attacks, or if other mood or behavior changes occur or worsen. Call your doctor immediately if you have suicidal thoughts or attempted suicides.
• 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?

• The drug is used to treat depression.
• Used to treat anxiety.
• This drug can be given to children for other indications. Consult your doctor.

What do I need to tell my doctor BEFORE my child takes this drug?

• If your child is allergic to this drug, any of its ingredients, other drugs, foods, or substances.Tell your doctor about the allergy and how your child has it.
• If your child is receiving any of the following: linezolid or methylene blue.
• If your child is receiving any of these drugs: Citalopram or pimozide.
• If your child has been taking drugs for depression or some other medical condition in the past 14 days. These include isocarboxazid, phenelzine, and tranylcypromine. An episode of very high blood pressure may occur.

This list of drugs and diseases that may be adversely associated with this drug is not exhaustive.

Talk to your doctor or pharmacist about all medications your child is taking (prescription and over-the-counter, natural products, and vitamins) and any health concerns. You need to make sure that this drug is safe for your child’s illness and in combination with other drugs he is already taking.You should not start, stop, or change the dosage of any drug your child is taking without talking to your doctor.

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

• Tell all health care providers for your child that your child is taking this drug. These are your child’s doctors, nurses, pharmacists and dentists.
• Have your child avoid tasks or activities that require attention until you see how this drug is working for your child.This includes cycling, playing sports, or using items such as scissors, lawn mowers, electric scooters, toy cars, or motorized vehicles.
• Do not suddenly stop giving this drug to your child without talking to your doctor. This can increase your child’s risk of side effects. If your child needs this drug, stop taking this drug gradually, as directed by the doctor.
• Alcohol may interact with this drug. Make sure your child does not drink alcohol.
• Consult with your child’s doctor before using marijuana, other forms of cannabis, prescription or over-the-counter drugs that may slow down your child’s actions.
• Sleep and appetite may improve quickly if you are depressed after starting this drug. Other symptoms of depressed mood may take up to 4 weeks to improve.
• This drug may increase the risk of bleeding. Sometimes bleeding can be life-threatening. Consult your doctor.
• This drug may lower sodium levels. Very low sodium levels can be life-threatening, leading to seizures, fainting, difficulty breathing, or death.
• In some cases, the drug may affect the growth rate in children and adolescents. They may need to check their growth rate regularly.Consult your doctor.

If your daughter is pregnant or breastfeeding:

• Consult a doctor if your daughter is pregnant, pregnant, or breastfeeding. The benefits and risks for your daughter and her 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 child’s healthcare provider right away?

WARNING / CAUTION: Although rare, this drug can cause very serious and sometimes deadly side effects in some people. Call your child’s doctor right away or get medical attention if your child has any of the following signs or symptoms that could be associated with a very bad side effect:

• Signs of an allergic reaction such as rash, hives, itching, reddened and swollen skin with blistering or scaling, possibly associated with 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, and balance problems.
• 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; bruising that occurs or increases for no reason; bleeding that you cannot stop.
• Convulsions.
• Fever or chills.
• Penile erection that lasts more than 4 hours.
• The risk of eye problems may be increased in some patients with this drug. Your child’s doctor may order your child to see an ophthalmologist to see if they are at increased risk of developing these eye problems. Call your doctor right away if your child develops eye pain, change in vision, swelling, or redness around the eye.
• A serious and sometimes fatal complication called serotonin syndrome can occur. This risk may be increased if the child is also taking certain other drugs. Call your child’s healthcare provider right away if the child develops anxiety, balance disorders, confusion, hallucinations, fever, tachycardia or irregular heartbeat, flushing, muscle twitching or stiffness, seizures, tremors or tremors, excessive sweating, severe diarrhea, nausea or vomiting, very bad headache.

If your child is or may be sexually active:

• Sexual problems such as decreased sex drive or ejaculation problems.

What are some other side effects of this drug?

Any drug can have side effects. However, many people have little or no side effects. Call your child’s doctor or get medical help if any of these or other side effects bothers your child or does not go away:

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

This list of potential side effects is not exhaustive. If you have any questions about side effects, talk to your child’s doctor. Talk to your child’s doctor about side effects.

You can report side effects to the National Health Office.

What is the best way to give this drug?

Give this drug to your child as directed by the doctor. Read all the information provided to you. Follow all instructions strictly.

All forms of issue:

• Give this drug with or without food.
• Continue giving this drug as directed by your child’s doctor or other healthcare professional, even if your child is well.

Oral solution:

• Measure liquid doses with care. Use the dispenser that comes with the medicine. If a dispenser is not included in the package, ask your pharmacist for a dosing product for this drug.

What if my child misses a dose of a drug?

• Give the missed dose as soon as possible.
• If it is time for your child to take the next dose, do not take the missed dose and then return to your child’s normal dosage schedule.
• Do not give a double dose at the same time or additional doses.

How do I store and / or discard this drug?

• Store at room temperature in a dry place. Do not store in the bathroom.
• Store 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 toilet or drain unless directed to do so. If you have any questions about the disposal of your medicinal products, consult your pharmacist. Your area may have drug recycling programs.

General information on medicinal products

• If your child’s symptoms or health problems do not improve, or if they get worse, see your child’s doctor.
• Do not share your child’s medicine with others or give anyone’s medicine to your child.
• Some medicines may have different patient information sheets. If you have questions about this drug, talk with your child’s doctor, nurse, pharmacist, or other healthcare professional.
• If you think there has been an overdose of a drug, call a Poison Control Center immediately or seek medical attention. Be prepared to tell or show which drug you took, how much and when it happened.

Use of information by consumer and limitation of liability

This information should not be used to make decisions about taking this or any other drug. Only the attending physician has the necessary knowledge and experience to make decisions about which drugs are suitable for a particular patient. This information does not guarantee that the drug is safe, effective, or approved for the treatment of any disease or specific patient.Here are only brief general information about this drug. It does NOT contain all available information on the possible use of the drug with instructions for use, warnings, precautions, information about interactions, side effects and risks that may be associated with this drug. This information should not be construed as a guide to treatment and does not replace the information provided to you by your healthcare professional. For complete information on the possible risks and benefits of taking this drug, consult your doctor.Use of this information is governed by the Lexicomp End User License Agreement available at https://www.wolterskluwer.com/en/solutions/lexicomp/about/eula.

Copyright

© UpToDate, Inc. and its affiliates and / or licensors, 2021. All rights reserved.

90,000 Say no to depression with Lexapro

Lexapro is one of the most popular antidepressants available over the counter. It is indicated for the treatment of depression and anxiety in adults.

Lexapro tablets are available only with a doctor’s prescription. Lexapro is taken at the rate of 1 tablet once a day. Try to take Lexapro at the same time with a cup of water. Never exceed the dosage of the medication, as this can lead to serious consequences.

Alcoholic beverages should be avoided while taking Lexapro. It is also not recommended to drive or operate machinery, as Lexapro can slow down your reaction, which can lead to accidents.

If you have kidney disease or are allergic to Lexapro components, you should have a doctor’s examination before you start taking Lexapro. It is not recommended to take Lexapro to pregnant women or women who are breastfeeding.

Information from the lexapro canada website.

Lexapro Tablets (Escitalopram) are prescribed for the treatment of certain mood changes, including depression. It is considered to be one of the best antidepressants available.

Lexapro belongs to the Selective Serotonin Reuptake Inhibitor (SSRI) drug category.The drug acts on chemicals in the brain that cause mood changes.

Taking medicine

Always follow your doctor’s recommendations when taking Lexapro. Never exceed the dosage of the medication, and also do not take Lexapro after the end of the course prescribed by your doctor, as it may be dangerous to your health. For best results, Lexapro is best taken at the same time every day. The tablets must be taken with water.

Also, do not interrupt Lexapro during your course of treatment, even if you feel well.Stopping the drug can negatively affect full recovery.

Dosage

Once you start taking Lexapro, never skip your medication. Missed doses will not give you the opportunity to achieve good results.

Also, do not overdose, it can adversely affect your health. If you experience rapid heartbeat, nausea, vomiting, sweating, seizures and dizziness, seek immediate medical attention.

More information

Never treat depression yourself and never take Lexapro without a doctor’s recommendation.

Doctors may not prescribe Lexapro for pregnant women or breastfeeding women because the tablets can be hazardous to the fetus and newborn babies.

Warnings

If you are going to use MAOI drugs, you should not start taking them earlier than 14 days after taking Lexapro.

Since the drug can cause suicidal ideation in the first few weeks, you should be under the constant supervision of your doctor.

Lexapro may impair vision and cause dizziness.

You must not consume alcohol or beverages for the entire Lexapro course. Also refrain from doing any heavy work after taking the pills.

Side effects

Some serious side effects may occur after taking Lexapro: mood changes, sleep problems, anxiety attacks, aggressive feelings, stiff muscles, restlessness, sweating, arrhythmias, high fever, nausea, loss of appetite, hallucinations, and seizures.

Escitalopram may have different names in different countries. For example, in Canada in pharmacies you can find this drug called Cipralex.

90,000 Depression in children and adolescents with cancer

Antidepressants

A doctor may prescribe a medication for depression. Antidepressants work over time. These drugs work to regulate the levels of neurotransmitters that scientists believe are responsible for depression.Some patients may require a combination of treatment with several drugs.

The following drugs may be used to treat depression in children and adolescents.

• Fluoxetine (Prozac®)
• Sertraline (Zoloft®)
• Citalopram (Celexa®)
• Escitalopram (Lexapro®)
• Venlafaxine (Effexor®)
• Duloxetine (Simbalta®)
• Bupropion (Wellbutrin®)

Patients taking antidepressants require medical supervision to monitor drug exposure and possible side effects.In rare cases, certain medications can cause violent behavior or increase the risk of suicide.

It is important to follow the dosage instructions carefully. Patients should not increase their doses or stop taking medications without consulting their doctor. If your symptoms of depression persist, be sure to tell your doctor.

Ask your doctor these questions when prescribing antidepressants:

• When will the symptoms of depression become less severe?
• Are there any contraindications for the simultaneous use of this drug with any other drugs or dietary supplements?
• What are the common side effects?
• Which side effects should be of particular concern to me?
• What to do if the time for taking the drug was missed?
• How long should this drug be taken?

Certain cancers and their treatment methods can alter the body’s response to certain drugs.It is possible that in this case it will be necessary to limit the range of antidepressants taken or even take prescribed drugs less often. Be sure to inform all doctors about any changes to your treatment plan and new medications. Also, if you have any doubts or concerns, do not hesitate to ask why your doctor is prescribing a particular drug.

Medicines for depression may be unsafe if taken more often or at higher doses than prescribed, or if they are stopped too soon.Be sure to check with your doctor before changing your dosage. Store medicines in a safe place out of the reach of children.

In depressed children and adolescents, it is necessary to monitor suicidal tendencies and worsening symptoms. Patients often require ongoing therapy to prevent recurrence of depression.

90,000 How I got off antidepressants. What is depression like, why without … | by Alexander Amzin

I am writing this article on Sunday evening just before New Years.I got up at 7:30 – an hour later than usual. Disassembled mail and file archive. I looked into the hunt for a couple of episodes of not at all positive TV series. In an hour and a half I prepared a digest for my channel for three days in advance. I remembered exercising, rocked, using a stool as a bench, waited for my muscles to ache.

Then my wife and I prepared dinner with four hands. If there is time left today, I will edit the layout of the book that came from the publisher, or meet with friends. I also do exercises every day, though not very actively, just to make my muscles ache.

Two years ago I could not afford this simple cheerful life. I was diagnosed with real depression, more specifically bipolar disorder. The surges of manic energy were followed by longer and longer periods of doing nothing. My battery was empty.

In English there is an expression to have too much on my plate. Each person has a metaphorical plate, and put on it no longer works. My plate shrank to the size of a tea saucer. I gave up one project after another.

However, there was no appetite to deal with the plate either. There was a hope to accumulate a small charge of energy, or at least wait for the next surge of cheerfulness. I tried to sleep in a dire condition. Shut out of life.

Surprisingly, my serious condition did not affect my creativity. I just did everything at the last moment for others as well. Own affairs were not done, and ideas were not implemented.

Gone is stability. After all, if you are not sure that you can invest every day, there is no point in relying on yourself.

Everything that is stated in this text is purely personal experience. It will not be completely suitable for anyone. Even me, because two years later I am a completely different person who reads my own diary with detached curiosity. The purpose of this text is to get you to see a doctor, and then gradually develop a program of action.

You must listen to your doctor. You can’t get off your antidepressants if they haven’t been prescribed to you. In so many cases, you simply won’t make it out without pills or any other prescriptions.If your doctor does not treat you well, find another. It is advisable to find a paid doctor.

If you are diagnosed with a depressive or similar condition , your doctor is called a psychiatrist, not a psychologist or a psychotherapist. He prescribes medications, not asks to talk about his childhood. He thinks (usually rightly) that your metabolism is broken. A psychologist and psychotherapist is a support group that may not be present at all in your life. For example, I didn’t go to a psychotherapist.I heard that it helps others.

If you are “just sad in life”, you should go to the doctor. Just in case. Nature created us vigorous and strong, sad and slow usually did not survive. Fortunately, the conditions for survival are now very mild, so even those who did not have a chance survive. For example, I have type 1 diabetes and would not need any depression to survive in the wild. If you do not have enough strength to live, work and enjoy your own efforts, see your doctor.

If you have seriously flashed suicidal thoughts, SEE YOUR DOCTOR URGENTLY. Never try to talk to a layman. If you are already taking some pills, the urgency doubles – the same antidepressants at some point can increase the desire to commit suicide.

Psychoactive substances are not the answer, although they can be a tool. Remember, medications are prescribed by the doctor. You control the rest and consult with the slightest doubt.If I now decide to take something potent without a prescription, I will definitely inform the doctor and in no case violate the prohibitions. For example, two doctors at once forbid me alcohol, which is already a depressant, and I do not drink. But, say, at the request of doctors, I have been drinking a lot of dangerous substances since the mid-nineties, starting with barbiturates at a rather tender age.

Ready? Then let’s go.

Surprisingly, when I was not depressed, I did not understand the meaning of the words used to describe depression.Having experienced it, I believe that any potential patient will recognize this state instantly. The rest will say “pull yourself together, rag.” It is impossible to describe, you can only survive. But, like the others, I will try to formulate.

Depression is a condition that destroys your will. To an outside observer, it looks more like laziness with indecision than sadness, with which it is usually compared.

A person does not feel in himself not only desires – the ability to perform even the simplest action.Many healthy people can easily imagine the reluctance to do exercises in the morning, almost turning into impossibility. Now amplify that sensation and apply it to things like getting up, drinking a glass of water, or brushing your teeth.

Since the outside world constantly presses on the patient, constantly forcing him to do certain things, he can withdraw into himself or, on the contrary, be irritable.

All this is often overlaid with various kinds of dependencies. Most often – food (cakes, sweets and fast food provide an apparent burst of energy for a short time) or game (it is much easier to get a sense of progress in the game space than in real life).

I didn’t come to reluctance to drink a glass of water. But spending two hours every day CHOOSING a game I would like to play and not making up my mind to do anything because of disgust is easy. If you recognize yourself in this description, see your damn doctor.

Aside from pharmacology, all techniques are reduced to one. The doctor, the pill, and some of the simple methods that will be discussed later will give you back the will to live. On the one hand, the desire to do something slowly returns to you.On the other hand, the joy of what has been done.

Why depression is bad? You cannot do anything. If you don’t do anything, you don’t get the result. If you don’t get the result, you don’t get a reward. Having not received a reward, you do not get motivation to move on to the next task. It is a vicious circle, a stranglehold that tightens around your neck.

To unravel the stranglehold, you must carefully and in a controlled manner accustom you to success, no matter how small. Then add some weight, make sure you hold.More. More. More. And so on to the superman. Joke.

By 1980, mankind had learned to jump almost 9 meters in length

Imagine that you live on the left bank of a river, and your target is on the right, just six meters away. And you are told that the only way to cross the river is in one jump. You open the encyclopedia and find out that at the end of the 19th century, men learned to jump 7 meters 23 centimeters. You are not a super athlete, but jumping 6 meters is within the limits of a person of the 21st century.But the trouble is, you can’t do it the first time. It takes a couple of years to train. NO PERSON can jump 6 meters in length without preparation.

The way out of the depths of the depression takes a long time. In the words “the desire to do something is slowly coming back” the keyword is “slow”. Moreover, I have bad news for you (I promise, the only one in this article). Your depression is likely to be with you for life. The good news is that it is in your power not to let her loose.The news is even better: the further you go down this path, the easier it is to control your depression.

Clearance from antidepressants begins long before the dose is reduced. See how everything was with you:

• I am not well
• I will not go to any doctor
• I went to the doctor
• Long diagnostics
• Long selection of the right drug
• The drug began to work after a few weeks, and I feel the difference
• And here are the side effects
• YOU ARE HERE

I have been in this business for a long time and I understand that the article will be read by those who have not yet gone to the doctor.GO TO HIM. Do not make any decisions before going to the doctor and at least five appointments with him, including corrective ones.

Let me tell you how I got to the point “YOU ARE HERE.”

I seem to have explained the first three points (not good, I will not go, go) in sufficient detail. In my case, a constant decrease in mood manifested itself, but I did not even think about any psychiatrist. I just complained to my epileptologist and got a referral to a psychiatrist.

Each case is unique.My uniqueness consisted of three points at once:

• habit and the need to work a lot and productively
• increased likelihood of depression due to diabetes
• a drug prescribed by an epileptologist, concurrently is prescribed by psychiatrists as a mood normalizer (at the beginning of the journey I talk about this did not know). Accordingly, he mitigated any symptoms and should not conflict with what the psychiatrist would prescribe in addition.

Therefore, the psychiatrist and the epileptologist knew each other and were in touch.

Long diagnostics. It took us weeks, if not months, to realize that what we thought was orgasm turned out to be asthma. Rather, the specialist needed to understand whether I was always like that, or whether my mood was changing. And if it changes, then how. And the frequency? And the seasonality? There are many other questions. Remember the mood-normalizing drug? Trying to catch mood swings against his background is not an easy task.

Long selection of the right drug. You are lucky if the prescribed medicine came up the first time.It is much more likely that on the way you will encounter crazy dreams, nausea, or the desire to do strange things. You may also find that even in the midst of chemical happiness, it is difficult to enjoy things that we simply must love, such as food or sex.

Taking almost any antidepressant is accompanied by side effects. It is the side effects that often lead us to try to reduce the dose. Ironically, the withdrawal period is characterized by its own delights (not covered in this article, but the habit itself can lead to a reluctance to ever return to antidepressants).

The moment when everything seems to start to work out for you, but there are nuances – the key in order to figure out how to continue to live.

The tablet returns you to a state of mind in which you can function normally. For a person who has experienced depression, this is literally a gift from heaven. Depressive episodes are quickly forgotten, and you enjoy the new state for several months.

Then it becomes not enough for you, because the side effects have not gone away. At this point, your brain incorrectly decides that it is necessary to get rid of the drug, and then we will somehow manage.

In fact, you need to use the strength of spirit that has appeared to organize your life while you can.

Under no circumstances should you take on too many obligations. We will train in long jump on the sly.

Like many others, I started my journey with a glass of water.

Installed the Fabulous application on the phone (after a while it becomes paid; there are drawbacks). Probably, you can use a notepad, an alarm clock on your phone, or something else; I am talking about my own experience.I emphasize that what follows should be read not as “the application saved me from depression”, but as “I found a tool that sharpened my will”.

Fabulous is about organizing your day. She does not interfere in your affairs. Instead, the slots of the routine appear – morning, afternoon and evening. You slowly bring in little good habits and make sure that everything in the routine is done. After a conditional week of a glass of water, a short warm-up will be added. Then a delicious breakfast. Then the obligatory item “celebrate success”.Then write a to-do list for the day. Etc.

Three routine slots form the frame of the tepee, that is, your day. Gradually, other important things are added to the frame.

One of them is managing your energy. The fact is that no application will help if you go to bed after midnight and get up by noon. Or if you don’t get enough sleep. Or, on the contrary, you will wallow for 16 hours in a row.

So at some point you will have to make a tough decision: go to bed before midnight and wake up early.For me, after many tests, it turned out to be convenient to go to bed at 23, wake up at 6:30. He held on for quite a long time, now I have stepped back from him a little, and from 2020 I will be back.

The idea of ​​getting up early is generally very productive. Remember how the whole world is imposed on a depressed person at once? So, the world is still sleeping at 6:30. You don’t have to check your mail. You can work for an hour on your secret project. Or think. Or keep a diary. Or, unexpectedly for yourself, prepare breakfast for your sleeping relatives; or go to a cafe for him.

You have one and a half to two hours free. Even if the new day is as depressing as the previous one, you will make some progress thanks to the morning hours.

Today I forgot to think about the meaning of life, as the application says to me.

It is necessary to kill at least a couple of months for this. At some point, you’ll get to the point where a friend, another article, or an app will ask you to meditate. Agree, but on your own terms.

These are the conditions:

• Each meditation should relieve you of anxiety or bring you closer to an important life decision.Try until you find your favorite type of meditation. Then try again;
• Meditation, auto-training or god knows what other tricks should strengthen two muscles. First, the will, which you will not have without pills. Secondly, the determination to live your own life, and not on orders from the outside. A healthy person can afford to go with the flow. You have an eternal calm, and to move, you have to row in the direction you want.
• Record the thoughts that have come, but do not necessarily re-read. You get stronger every week.And although progress is not immediately apparent, why would you re-read the wimp’s diary?

Your day should become a self-sustaining system that makes you simultaneously move forward, think about the goal, relax and go to sleep with a sense of accomplishment.

They say that in order to grow a beard from the outside, you must grow it from the inside. It is the same with discipline, will and determination.

And don’t forget to praise yourself for every achievement. Your day is not a quitrent that you pay to yourself.These are carefully selected actions that improve your life every day (the “60 minutes for a secret project” clause in Fabulous brought me – and unknowing readers so much joy!).

At some point I realized that I was ready.

Artificial chemical mood elevation no longer solved the problem of low productivity. I could do without him, doing more than half of what was planned for the day in 2-3 hours in the morning.

Sleep returned to normal.

I strictly adhered to the schedule and almost finished the plump diary book.

A huge long list of to-do’s, including forgotten ones, was gradually reduced, making room for something new.

Entertainment began to seem meaningless in many ways, because it turned out to be more interesting to be engaged in a secret project, to achieve something in other projects, to think of something new and implement it. It’s incomparable to on-screen adventures and sticky games. The moment when living in reality becomes more interesting than in virtuality is key. It shows that the environment has ceased to control you.Conversely, if you notice that you are less and less attracted to accomplishments and more and more to entertainment, you should take it as a bell.

I refused some responsibilities, some, on the contrary, imputed to myself. For example, he resumed the daily maintenance of his telegram channel. This is also a kind of exercise, pumping expertise every day.

So I went to the doctor and we started to gradually reduce the dosage. Very gradually. Very slow.

I hardly remember my feelings, others quickly layered on them.

Likely there was some kind of material resistance. It became a little more difficult to carry out the already familiar plans, but then it turned out that it was not so difficult. But there was no more despair and the feeling of being unable to move. It didn’t seem too much to get through the day.

By that time, I was solving a completely different problem, namely, what is the purpose of the next week, month, year and life? In one day, such a task is not something that you cannot solve – you cannot even set it. Between the production and the outline of the solution, there were dozens of pages scribbled in the morning.

The six-meter river was behind, wider reservoirs were in front. Now I’m working on my own startup, and I’m trying on what I’ll do when I succeed.

Never once did I think of getting off antidepressants as a goal. Yes, and I climbed on them in an instrumental manner.

I went to see a psychiatrist a few months ago.

– How do you feel? She asked.

“Excellent,” I replied. – Only one problem.

– Which one? She asked.

– Nobody told me that normal people live so boringly. Not sad or depressed, but boring, day in and day out, ”I said.

The psychiatrist laughed:

– Well, that’s what we fought for. Drink vitamin D, go for a walk, spend more time in the sun.

One of the most important lessons I have learned from dealing with depression is that the world is neither good nor bad. He just is. It is in our power to make it better, we have all the opportunities for this, but we need to invest seriously in order to move forward.

If you are on antidepressants, you can happily challenge the world.

If, on the contrary, you are sick, then at the words “seriously invest” you will turn over and try to forget.

A normal person has an opportunity.

He has to earn on desire, will and passion.

–

Sasha Amzin, [email protected]

Postscript

Thank you very much for your very positive response. The article turned out to be useful, which means that something needs to be clarified, including at the request of the doctors.

• “Getting off antidepressants” does not mean being cured. Many mental illnesses are untreated. But often (not always) it is possible to achieve an equilibrium state and reduce the intake of drugs to a minimum. In such a controlled state, in the absence of external crises, one can stay for quite a long time. The doctor and only the doctor will help to achieve balance.
• Depression, anxiety disorder, bipolar disorder,% write the diagnosis% – all this can come back at any time.