Lexapro side effects and how to avoid them

Creator: SingleCare
Published: 2021-06-30T15:33:04-04:00

Lexapro treats major depressive disorder and generalized anxiety disorder. Before starting Lexapro, it’s important to know the possible side effects and how to minimize them.

By SingleCare Team | Jun. 30, 2021 Medically reviewed by Gerardo Sison, Pharm.D.

Lexapro is a brand-name prescription antidepressant that treats major depressive disorder and generalized anxiety disorder. Escitalopram oxalate, the active ingredient in Lexapro, is a selective serotonin reuptake inhibitor, or SSRI. It works by increasing a chemical in the brain called serotonin that transmits nerve signals to help regulate mood and feelings of well-being, as well as sleep and appetite. Although it’s effective at treating depression and anxiety, Lexapro may cause side effects. Before starting Lexapro, it’s important to review possible side effects and possible ways to minimize them.

RELATED: Learn more about Lexapro

Common side effects of Lexapro

The most common side effects of Lexapro include:

Nausea
Trouble sleeping
Diarrhea
Sexual dysfunction, including decreased sex drive, erection problems, and orgasm problems
Sleepiness
Dry mouth
Fatigue
Dizziness
Sweating
Constipation
Weakness
Nervousness
Loss of appetite
Dizziness
Yawning

Children and adolescents taking Lexapro may experience additional side effects such as:

Increased thirst
Agitated muscle movements
Nosebleeds
Problems urinating
Menstrual problems
Slowed growth

Common side effects of Lexapro

Lexapro can cause serious side effects including:

Suicidal thoughts and behaviors
Worsening depression
Serotonin syndrome
Bleeding problems
Mania or hypomania
Angle-closure glaucoma
Low sodium levels in the blood
Changes in heart rhythm

Lexapro and suicide

Children, adolescents, and young adults taking Lexapro have an increased risk of worsening depression, suicidal thoughts, and suicidal behaviors. Younger patients taking Lexapro should be closely monitored for signs of suicidality such as:

Suicide attempts
Thoughts about suicide or death
New or worsening depression
New or worsening anxiety
Mood changes
Panic attacks
Agitation, restlessness, irritability, or aggression
Unusual behaviors
Risky behaviors

Lexapro and serotonin syndrome

Serotonin syndrome is a rare condition caused by taking too many medications that increase serotonin levels in the brain. Too much serotonin can lead to toxicity and symptoms that can range from mildly unpleasant to potentially fatal. Because serotonin syndrome is typically caused by drug interactions or overdoses, the primary treatment is to identify the problematic drugs and discontinue taking them. Medical attention may also be needed. The symptoms of serotonin syndrome are:

Agitation
Hallucinations
Loss of coordination
Muscle twitching and overactive reflexes
Rigid muscles
Rapid heartbeat
High or low blood pressure
Rapid breathing
Sweating or fever
Nausea
Vomiting
Diarrhea
Confusion
Mood changes
Dilated pupils

Lexapro and low blood sodium

Lexapro may throw off the hormones that regulate the body’s elimination of water and salt, causing sodium levels in the blood to fall, a condition called hyponatremia. Elderly patients are particularly vulnerable to low sodium. When taking Lexapro, watch for any symptoms of hyponatremia including:

Changes in mental functioning, such as confusion, memory problems, difficulty thinking, or hallucinations
Headache
Unsteadiness
Fainting

Severe hyponatremia can result in seizures or coma.

Lexapro and angle-closure glaucoma

Angle-closure glaucoma is a serious condition that can happen suddenly and without warning. It occurs when the space between the iris and the cornea (called the drainage angle) becomes narrowed or blocked, which can result in reduced fluid drainage from the eye. Lexapro can dilate the pupils and trigger an angle-closure glaucoma attack. If left untreated, fluid pressure can build up rapidly within the eye, causing vision loss or blindness in a matter of hours. When taking Lexapro, stop taking the drug and immediately go to an emergency room at any sign of angle-closure glaucoma, such as:

Eye pain
Vision changes
Swelling or redness in or around the eye
Headache

Lexapro and heart rhythm

All SSRIs can change the heart’s rhythm in ways easily identifiable on an electrocardiogram (ECG). A doctor will call these changes “QT prolongation” and “torsade de pointes,” but the point is that the heart is not beating correctly. In severe cases, these changes could cause fatal arrhythmias. Among the SSRIs, the active ingredient in Lexapro (escitalopram) and the active ingredient in Celexa (citalopram) have the greatest effect on heart rhythm. People with heart problems may need to have regular ECGs to monitor Lexapro’s effects on the heart.

Lexapro and weight changes

Although weight changes, such as weight gain or weight loss, are popularly associated with antidepressants, clinical trials showed that Lexapro does not affect weight. Lexapro may, however, slow down growth when given to children.

How long do Lexapro side effects last

Lexapro side effects are usually temporary. Many, such as dry mouth, headache, and nausea, go away within a couple weeks as the body adjusts to Lexapro. Unfortunately, severe side effects may persist longer. Serotonin syndrome typically resolves within two to three days of discontinuing all medications affecting serotonin, but the most severe cases may take several weeks before symptoms fade. Lexapro’s effects on sodium levels will resolve about two weeks after the medicine is discontinued. Treatment usually involves taking a diuretic and limiting water intake, but severe low sodium levels may require hospitalization. Some of the most severe side effects, such as angle-closure glaucoma, may evolve into chronic and lifetime conditions.

Lexapro contraindications & warnings

Like any other drug that affects the central nervous system, Lexapro may cause problems in some people. The use of Lexapro may need to be avoided in certain people depending on their medical condition and other medications they may be taking. Therefore, a healthcare provider should be consulted to determine if Lexapro is an appropriate antidepressant.

Abuse and dependence

Based on animal studies, the U.S. Food and Drug Administration (FDA) does not consider Lexapro a controlled substance that carries a risk of physical dependence, abuse, or tolerance. There is no evidence that the drug is harmful when taken over a long period of time, but doctors and other healthcare providers may be advised to monitor people with a history of drug abuse to make sure any prescription Lexapro is not being abused or diverted.

Overdose

An overdose of Lexapro can cause serious medical problems, especially if other drugs or alcohol are also involved. Symptoms of a mild to moderate Lexapro overdose include:

Dizziness
Sleepiness
Sweating
Confusion
Blood pressure changes
Nausea and vomiting

If large amounts of Lexapro are taken, serious side effects could include health-threatening changes to heart rhythm, seizures, and coma. A person experiencing a suspected Lexapro overdose should receive immediate medical attention.

Restrictions

Because of potential hazards, some people should never take Lexapro.

Anyone with allergies to Lexapro should not take the medication.
Anyone taking a monoamine oxidase inhibitor, or MAOI, should not take Lexapro until they’ve been off the MAOI for at least two weeks.

Some people who can safely take Lexapro, however, may be at an increased risk of side effects or other problems because of pre-existing conditions. In those cases, Lexapro is used cautiously and sometimes with extra monitoring to spot problems before they become serious.

Because of the risk of suicide, people younger than the age of 25 taking Lexapro should be carefully watched for signs of worsening depression, unusual behaviors, risk-taking, impulsiveness, or suicidality. Any signs of worsening depression or suicidality should be immediately reported to the doctor prescribing Lexapro.
Lexapro will require careful dosing and monitoring in people with liver, kidney, or heart problems. People with a history of unusual heart rhythms, congestive heart failure, or heart attack may require regular ECGs to keep track of Lexapro’s effects on the heart.
Because of the risk of low sodium, Lexapro will require careful dosing and regular monitoring in people with electrolyte problems, blood volume problems, or people of advanced age.
All antidepressants can turn depression into mania or hypomania in people with bipolar disorder or a history of mania. People predisposed to mania will require careful monitoring as they take Lexapro. Behaviors need to be closely watched and any behavior changes reported to the doctor prescribing Lexapro.
People with uncorrected narrow angles are at a higher risk of narrow-angle glaucoma, so they should closely monitor any eye problems when taking Lexapro.
Lexapro interferes with blood clotting, so people with bleeding problems or taking blood-thinning drugs may need to be monitored.
Lexapro lowers the seizure threshold, so people with a history of seizures will require monitoring while taking Lexapro.
Women in the third trimester of pregnancy will face a choice of continuing or stopping Lexapro. The drug does not cause birth defects or premature birth, but it does increase the risk of a baby being born with pulmonary hypertension or poor adaptation.
Because both escitalopram and its active metabolite are present in breast milk, women who are nursing should watch their breastfeeding infant carefully for signs that the drug is affecting the baby, such as sedation, agitation, restlessness, and any problems with feeding or weight gain.
Lexapro is not approved for use in children younger than the age of 12, although some doctors or healthcare providers may prescribe it off-label for children as young as 6 years of age.

Lexapro interactions

Lexapro can interact with several over-the-counter and prescription drugs. Most drug interactions are minor, but some can grow into serious medical problems.

Lexapro should never be combined with monoamine oxidase inhibitors, or MAOIs.
Lexapro can never be used with the antipsychotic drug pimozide. It should also be used with caution while taking other antipsychotic drugs like thioridazine.
Drugs that raise serotonin levels—called serotonergic drugs—should be avoided or used carefully while taking Lexapro. These include other antidepressant medications, anxiety medications, antipsychotics, bipolar disorder medications, migraine drugs, amphetamines, opioids, seizure medications, antiemetics (drugs that treat nausea or motion sickness), and Parkinson’s disease medications.
Certain herbal and dietary supplements, such as St. John’s wort and tryptophan, should be avoided when taking Lexapro.
Lexapro should be used cautiously with drugs that affect the heart, such as amiodarone and quinidine.
NSAIDs (nonsteroidal anti-inflammatory drugs) such as aspirin, ibuprofen, or naproxen can interfere with blood clotting, so they may need to be avoided when taking Lexapro.

This may not be a complete list of drug interactions, so it’s best to consult a healthcare provider about all possible drug interactions before taking Lexapro.

How to avoid Lexapro side effects

Lexapro and other SSRIs are commonly prescribed not only because they work, but because many people experience no or minimal side effects when taking them. A few rules-of-thumb can help minimize side effects:

1. Take Lexapro as directed

Take the dose prescribed, usually 10 mg once daily. Don’t take extra medicine or skip a dose. Lexapro can be taken with a meal or on an empty stomach.

2. Tell the doctor about all medical conditions

Adverse effects can be better avoided if the healthcare provider prescribing Lexapro knows about all past and present medical conditions, especially:

Liver problems
Kidney problems
Heart problems
Electrolyte problems
Bleeding or bruising problems
Mania or bipolar disorder
Any history of seizures
Any history of stroke
High blood pressure
Pregnancy or pregnancy plans
Any history of drug or alcohol abuse

3. Tell the doctor about all medications being taken

Many of Lexapro’s side effects can be provoked or worsened by drug interactions, so make sure the healthcare professional prescribing Lexapro knows about other medications and supplements being taken.

4. Take Lexapro at the same time every day

For maximum benefit, Lexapro should be taken at the same time every day. Pick a time and always take a daily dose at that time. You should also pick a time that reduces the impact of side effects. For instance, if Lexapro is causing sleeplessness, switch the daily dose to the morning. If Lexapro is causing drowsiness, move the daily dose to the evening.

5. Do not stop taking Lexapro

Suddenly stopping Lexapro may cause withdrawal symptoms, such as irritability, headache, nausea, and dizziness. To avoid withdrawal symptoms, a healthcare provider will recommend tapering, or slowly decreasing, the dose of Lexapro over time.

6. Do not skip doses

Antidepressants work best when taken every day over a long period. Skipping doses on purpose or by accident will not help reduce side effects but will reduce the therapeutic benefits of taking the drug.