Depression and anxiety are the most common mental health issues in the United States, and they are among the most common healthcare issues that American’s face each year. Mental health problems are complex, and there are many approaches to consider when treating them. Medications can be used, sometimes in conjunction with psychotherapy. A class of drugs called antidepressants can be used to treat both clinical depression and anxiety disorders

These drugs can help correct or compensate for chemical imbalances in the brain that contribute to mood problems and anxiety. Escitalopram is one such antidepressant that is frequently prescribed in the United States. However, like all prescription medications, escitalopram does have some side effects you should be aware of before taking it.

Learn more about escitalopram and the potential side effects that you may encounter. 

Escitalopram is a prescription drug that’s sold under the brand name Lexapro. It’s used to treat depression and anxiety disorders. Escitalopram is a selective serotonin reuptake inhibitor (SSRI), which is one of the most common categories of prescription drugs that are used to treat clinical depression. SSRIs work with a natural chemical in your brain called serotonin, which is involved in regulating your mood. Serotonin levels can have a significant impact on your mood and sense of contentment. SSRIs like escitalopram block the reuptake of serotonin, which means that it prevents the chemical from being removed from your system for a certain amount of time. This allows serotonin to build up, raising your serotonin levels and your mood. SSRIs aren’t effective for everyone that has a mood or anxiety disorder, but they can be useful medications in treating mental health. 

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SSRIs like escitalopram aren’t controlled substances that are scheduled on the same level as many other psychoactive substances like opioids or central nervous system depressants. Instead, they just require a prescription to purchase and don’t come with extra scrutiny. This is because escitalopram has shown to have a very low risk for things like misuse, dependence, and addiction. 

According to the FDA, there hasn’t been a systematic study into the misuse liability of the drug, but the clinical trials and animal studies have revealed no drug-seeking behavior. Still, because misuse liability can be unpredictable with different drugs, the Food and Drug Administration warns that physicians should examine a patient’s history with drug use and misuse before prescribing escitalopram. But escitalopram isn’t known to cause a significant euphoric effect like most drugs of abuse can. 

It’s also not known to cause severe physical dependence, which is when your body comes to rely on a drug that can cause withdrawal symptoms when you try to quit. It is possible to feel some side effects after you stop using the drug, especially effects that have to do with the rebound of symptoms like anxiety and depression. It’s always a good idea to speak to your doctor or pharmacist before adjusting your dose or quitting a prescription.

Escitalopram is thought to be relatively safe during an overdose. While taking a high dose can increase your risk of experiencing certain side effects, it’s not likely to be fatal. According to the FDA, there were some overdoses during clinical trials as high as 600 mg, which is around 30 times a standard dose of Lexapro. There were no reported fatalities in association with these high doses. After the drug was released, the FDA tracked reports of overdoses, and some were as high as 1000 mg, and fatalities in patients who have taken escitalopram are rarely reported. 

Still, while escitalopram isn’t likely to cause a deadly overdose, high doses can cause unpleasant and potentially dangerous symptoms. Common symptoms of an overdose include hypotension, insomnia, nausea, vomiting, sleepiness, and dizziness. More dangerous symptoms could include coma, convulsions, and heart-related complications. Rare instances of renal failure have also occurred. In many of these cases, escitalopram was also combined with other drugs. 

Mixing drugs can make a prescription more dangerous, and it’s important to talk to your doctor before taking a new prescription when you’re already on one. Read the label or ask your pharmacist if an over-the-counter drug you’re interested in may interact with your prescription. 

Antidepressants and other drugs that are active in your central nervous system are sometimes associated with sexual side effects that hinder sexual ability to desire. It’s often difficult to get accurate statistics on sexual dysfunction because patients are sometimes reluctant to talk about or report sexual symptoms. 

SSRIs can sometimes affect sexual function in both men and women. According to the FDA, escitalopram was shown to cause an ejaculation delay disorder in 12% of men in a placebo-controlled clinical trial. It was also associated with decreased libido in 6% and importance in 2% of men. Women experienced a decreased libido at a rate of 3%, and anorgasmia (the inability to achieve orgasm) also at a rate of 3%. Priapism, which is the name for painful and long-lasting erection, is often sometimes associated with SSRIs.

However, the FDA also points out that there has not been a study that specifically investigated the effects of escitalopram on sexual dysfunction. The study’s that reported sexual dysfunction were broad investigations as to the effects and side effects of the drug.  

Insomnia is a concern when you’re taking an SSRI like escitalopram. The FDA advises doctors to monitor patients for insomnia when taking the drug and right after you stop taking it. Sleep problems are commonly associated with mental health problems like depression and anxiety. While insomnia can seem like a routine, mild problem, it can lead to some serious consequences. A lack of sleep can cause you to struggle with low energy and cognitive impairment the next day. Chronic insomnia can also cause weight gain, obesity, type 2 diabetes, heart disease, and mental health issues. 

Sleep problems can leave you feeling frustrated, fatigued, and stressed out, which can worsen or contribute to depression and anxiety. Anxiety and depression can also keep you awake at night, causing you to develop sleep problems. Because insomnia can contribute to issues like anxiety and depression and vice versa, sleep and mental health problems can feed into one another. 

Any medication that affects important neurotransmitters in your nervous system could have an impact on a complex process like sleep. When you start taking escitalopram, it’s important to monitor your sleep quality, as you would monitor any other symptoms and side effects. You should also monitor your sleep when you stop taking an SSRI. The FDA reports that a study found that 1% of people that stopped taking escitalopram experienced insomnia. While that’s a very small amount, it was at least twice the rate of those taking a placebo. 

There are several common physical side effects that are associated with escitalopram. Most are mild and well-tolerated. However, if a side effect is persistent or uncomfortable, you should let your doctor know. In some cases, you can change your dose or find a new medication to minimize side effects while treating mental health problems. Common side effects include:

  • Headaches 
  • Nausea
  • Dry mouth
  • Constipation
  • Fatigue
  • Drowsiness dizziness
  • Sweating 

While more severe side effects are rare, they are possible, and it’s important to monitor your symptoms when taking any new prescription. Some heart-related changes are possible when taking escitalopram, and you may experience an increase or decrease in your heart rate. For the most part, these symptoms aren’t life-threatening. But if you have a heart-related medical condition or complication, it may be affected by an SSRI. Other more severe but rare side effects include bloody stools, fainting, seizures, swelling or pain in your eyes, blurred vision, or dilated pupils. These symptoms could indicate a medical emergency and require immediate medical attention.  

Even though escitalopram is intended to treat mental health issues, it can sometimes cause some psychological side effects. In some cases, drugs that interact with serotonin can cause serotonin syndrome, which is characterized by physical symptoms like diarrhea, seizures, and heart palpitations. But it can also cause agitation, anxiety, restlessness, confusion, and panic attacks. Serotonin is closely tied to mood, and elevating the levels of it in your system should have a positive effect on your mood. However, it can also lead to a heightened state of vigilance, alertness, and nervousness that can cause anxiety. 

One of the most concerning potential psychological effects of escitalopram is the worsening of depression. The FDA even warns prescribers that people with major depression can experience a worsening of clinical depression and the development of suicidal thoughts. There is some concern that SSRIs may contribute to negative changes in depression symptoms. The FDA reported a study that showed moderate increases in suicidality among people that took SSRIs compared to placebos. The increase in suicidality was most pronounced in adolescents under 18, with 14 additional cases over placebos per 1000 patients.  

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