Lexapro (escitalopram) is a common brand-name antidepressant. This selective serotonin reuptake inhibitor (SSRI) treats anxiety and depression by decreasing serotonin breakdown in the brain. Those with depression or anxiety may be prescribed Lexapro in addition to lifestyle changes and therapies in order to help better control and minimize symptoms. Lexapro is a popular treatment option, but consulting a doctor about side effects is critical to understanding what to expect and determining the best medication for patients’ specific needs.
RELATED: List of SSRIs
COVID-19 and mental health
The incidence of generalized anxiety disorder and depression has ramped up from the stress of the COVID-19 pandemic. From January to February 2021, the Centers for Disease Control and Prevention (CDC) reported that more than 2 in 5 adults ages 18 years or older experienced symptoms of anxiety or depression within the past seven days of being surveyed. In one SingleCare survey of 2,000 people, 62% of respondents experienced some degree of anxiety, which was more common in women than men.
In an analysis of SingleCare prescription data, we found that prescription fills for generic Lexapro had increased 70% in 2020. Lexapro treats general anxiety disorder, anxiety with depression, and major depressive disorder. It can also be an off-label treatment for panic attacks, insomnia, and obsessive-compulsive disorder (OCD). Serotonin, the chemical that Lexapro increases in the brain, is considered a “happy hormone” that’s responsible for stabilizing mood, causing a feeling of well-being, and increasing happiness.
Depression and anxiety in women
Research shows that women can experience different or more severe symptoms of anxiety and depression compared to men. One specific difference is the cause of anxiety and depression, specifically how women can experience postpartum or menopausal depression.
According to the DSM-IV, a manual for assessing and diagnosing mental disorders, women are more likely than men to experience the following symptoms of anxiety and depression:
- Less sleep
- Decreased appetite
- Decreased energy
- Slow psychomotor changes
- Increased interpersonal sensitivity
- Leaden paralysis (feeling of heavy limbs)
- Somatic complaints (feeling pain)
What are common Lexapro side effects in women?
The efficacy of medications, especially SSRIs, varies. Women may respond better to SSRIs than men since symptoms and causes of depression and anxiety commonly differ from men.
Although inconclusive, studies show a trend that women respond better to SSRIs because they have slightly different body chemistry than men. In general, Lexapro tends to accumulate more in women and does not eliminate as fast as it does in men. Men and women tend to have similar side effects to Lexapro, but limited data suggests women tend to experience these side effects more often than men.
The current guidelines do not suggest starting women at lower doses of Lexapro because the studies have not been definitive and the side effect differences are considered to be clinically insignificant. Due to the trends in the available data, it is recommended to lower doses as needed on a patient-specific basis if someone is experiencing side effects or difficulty with Lexapro.
Common side effects of Lexapro may include:
- Dry mouth
- Painful urination
- Decreased libido
- Decreased appetite
- Nasal congestion
- Blurred vision and insomnia
- Weight gain
Sexual side effects appear in both men and women from antidepressants. While women might experience low libido, delayed lubrication, or blocked orgasms, men can also experience sexual dysfunction including low libido or trouble maintaining an erection.
There is an increased risk of suicide in young adults taking Lexapro. Patients younger than 25 years of age should carefully monitor their symptoms while taking Lexapro and report any unusual or worsening symptoms to their provider immediately.
When deciding if Lexapro is right for you, it’s imperative to discuss possible side effects with your doctor. Any medication can come with side effects, and it’s up to you and your doctor to determine if the benefits outweigh possible side effects.
Lexapro and pregnancy
Pregnant women should discuss depression and anxiety symptoms with their providers to determine the best route of treatment. At present, the FDA has not found significant evidence that Lexapro should not be used during pregnancy.
“As a pharmacist specializing in women’s health, I see Lexapro used frequently in pregnant women who require treatment for depression,” says Sierra Richard, Pharm.D., a women’s health and pediatric clinical pharmacist. “Every woman should have access to individualized therapy options to treat their depression while pregnant.”
According to the American College of Obstetrics and Gynecology, the impact of untreated depression on pregnancy can lead to worse outcomes than the risks associated with receiving treatment. Women who discontinued their antidepressant were five times more likely to have a depression relapse than those who continued their antidepressant. Pregnant women should work with a healthcare professional to choose a safe, effective treatment plan to address anxiety and depression symptoms, weighing risks and benefits.
A 2016 study found antidepressants taken in the first trimester can raise the chances of a miscarriage. The National Alliance of Mental Illness (NAMI) warns that SSRIs taken during the second and third trimesters have more risks. There is a chance that the baby can be born before reaching full development at 37 weeks gestation. There is also the risk of infants developing persistent pulmonary hypertension in the neonate (PPHN), which is a potentially fatal condition that involves restricting oxygen and blood flow due to lung vessels not being open wide enough. However, there is less than a 1% chance of developing PPHN.
NAMI states that Lexapro used during pregnancy can cause newborn babies to be born with withdrawal symptoms, including respiratory distress, irritability, and poor feeding. The CDC found an increased risk of congenital disabilities by two to three times. While this is a significant statistic, the CDC states birth defects from SSRIs are still extremely low. Although there are risks, there is limited research to confirm the likelihood and severity of adverse effects on pregnancy and newborns. Even with risks, it is still important to be aware of these potential adverse effects when considering treatment options while pregnant.
If you are planning to get pregnant, you may be able to stop your medications. Discuss changing or discontinuing medications with your healthcare team before making any changes. Your physician may advise stopping, tapering, or continuing Lexapro.
Lexapro while breastfeeding
Research shows that taking Lexapro up to 20 mg will minimally pass into breast milk and should not cause adverse effects for a baby, especially if the baby is older than 2 months. Women who are taking Lexapro while nursing should watch for signs of side effects in their baby. These include drowsiness, agitation, restlessness, and problems with feeding or weight gain.
Lexapro for menopause
Menopausal women experience physical, emotional, and mental changes. Vasomotor symptoms of menopause include hot flashes, night sweats, and skin flushing. About 80% of women experience these vasomotor symptoms during menopause. Off-label treatment with SSRIs can help combat these symptoms.
In addition to physical symptoms of menopause, a study shows women can benefit from SSRIs to address depression and trouble sleeping. Side effects other than hot flashes, night sweats, depression, and insomnia should be addressed with a doctor. These may be treated with hormone therapy or other medications.
How to take Lexapro to avoid side effects
Take Lexapro and other SSRIs as directed. Lexapro is an oral medication. It’s available as tablets of 5 mg, 10 mg, or maximum doses of 20 mg. The recommended starting dose is 10 mg, which can be increased as needed. Take Lexapro once per day with or without food.
It usually takes two weeks to start seeing results and four to six weeks before feeling the full benefits of Lexapro. SSRIs can take weeks to build up in the body and reduce symptoms. This is important to note because, unlike many medications, Lexapro will not have much of an effect at first. It may be tempting to stop taking it in the beginning weeks of treatment due to a lack of symptom relief for depression. However, it is important to take it for at least two months to see if it is an effective treatment.
Do not stop taking the medication without talking to your healthcare provider. Stopping Lexapro without tapering can lead to serious side effects, including suicidal thoughts, and withdrawal symptoms including dizziness, muscle tension, chills, confusion, trouble concentrating, trouble remembering things, and crying.
Avoiding food and drug interactions
People taking Lexapro should be aware of possible food and drug interactions. Do not mix alcohol or tobacco with Lexapro. While the majority of food and drink don’t adversely react to Lexapro, grapefruit juice can affect Lexapro. Consuming grapefruit juice can increase the amount of Lexapro in the body, increasing the risk of side effects.
Lexapro may also interact with prescription drugs, over-the-counter medicine, and even certain supplements. Tell your provider all medications you take so he or she can prescribe the best drugs and dosage. If Lexapro is taken with another medication that affects serotonin levels, such as monoamine oxidase inhibitors, it can result in a life-threatening condition called serotonin syndrome. Lexapro may also increase the risk of bleeding problems, so seek medical advice before taking it with nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or blood thinners like warfarin.
If you’re living with anxiety or depression, medication can help reduce your symptoms and improve your quality of life. Lexapro works best when combined with lifestyle modifications and therapies in order to get a complete treatment plan. Before starting or discontinuing Lexapro, discuss your unique circumstances and plans for the future (including plans to conceive). Your provider can help determine if Lexapro is right for you.