Medical Review by Jennie Stanford, MD, FAAFP, DipABOM
Summary
- Lexapro® (escitalopram) is a prescription antidepressant used to treat major depressive disorder (MDD) and generalized anxiety disorder (GAD) by balancing serotonin levels in the brain.
- Common side effects include insomnia, sexual dysfunction, increased sweating, fatigue, and nausea, especially during the first few weeks as your body adjusts.
- Serious side effects that need immediate medical attention include suicidal thoughts, signs of mania, seizures, sudden vision problems, unusual bleeding, and serotonin syndrome.
- Contact your healthcare provider if you notice any new or worsening symptoms to manage side effects and adjust your treatment if needed.
Here’s what you need to know as you start taking Lexapro®
Lexapro® (escitalopram) is a prescription antidepressant that belongs to a class of drugs called selective serotonin reuptake inhibitors (SSRIs). It’s commonly used to treat major depressive disorder (MDD) and generalized anxiety disorder (GAD) by helping to balance serotonin levels in the brain.
Lexapro® can improve your mood, energy levels, and balances your emotions while reducing anxiety and stress. But it can also come with side effects that you should understand before taking it.
In this article, we’ll dive deeper into Lexapro®’s side effects, and explain why they happen, how they can affect your body, and when to seek help from a healthcare professional.
Common side effects
Side effects can occur with Lexapro®, especially when you first start taking the medication. As your body adjusts, you may notice a variety of symptoms ranging from mild to more noticeable.
These side effects are typically most prominent during the first few weeks of treatment as your body adapts to changes in serotonin levels. These are the most common side effects of Lexapro®.
Insomnia
Insomnia is when you have trouble falling asleep, staying asleep, or getting good quality sleep, which leads to problems during the day.
Increasing serotonin levels with medications, like Lexapro® and other SSRIs, can disrupt your sleep because serotonin promotes wakefulness, making it harder for you to fall asleep. Serotonin also helps produce melatonin, the hormone that regulates the sleep-wake cycle. When serotonin levels change, it can affect melatonin production, making it harder to sleep as well.
People with depression or anxiety often have sleep issues, which are key symptoms in diagnosing both major depressive disorder (MDD) and generalized anxiety disorder (GAD). Escitalopram has been found to be more effective than other SSRIs at improving sleep problems.
Sexual dysfunction
Sexual dysfunction includes issues like ejaculatory delay (taking longer to ejaculate), erectile dysfunction, lower sex drive, and anorgasmia (making it harder to have an orgasm).
When you take SSRIs, the higher serotonin levels block the brain’s dopamine and norepinephrine pathways, which are important for desire and arousal. Most serotonin is found outside the brain, and when levels are higher, it can reduce sensations in the genitals.
This can lead to erectile dysfunction, low vaginal lubrication, and orgasm problems. Serotonin also blocks the production of nitric oxide, which helps relax blood vessels. Without this, there’s less blood flow to your genitals, which can affect sexual function.
In clinical trials, 12% of males taking Lexapro® had ejaculatory delay, compared to 1% with a placebo. Erectile dysfunction affected 2% of males versus 1% on placebo. For females, 3% had trouble reaching orgasm, compared to less than 1% on placebo. In both males and females, 3% experienced a decrease in libido.
Increased sweating
Excessive sweating is a common and uncomfortable side effect of using antidepressants, with about 10% of people on SSRIs experiencing it. The exact cause isn’t fully understood, but it’s believed that SSRIs affect serotonin levels in the hypothalamus, the part of your brain that controls your body temperature. This serotonin change may lead to your body sweating more than it should.
Fatigue & tiredness
Fatigue is the feeling of being both physically and mentally tired. Fatigue from SSRIs like Lexapro® can happen in two ways:
- SSRIs can disrupt your sleep-wake cycle by raising serotonin levels, leading to many nights of bad sleep and daytime tiredness.
- Serotonin may interfere with dopamine and your body’s stress response, which can also cause fatigue.
Nausea
When taking Lexapro®, you may experience nausea because it increases serotonin levels in your body. Approximately 90% of your serotonin is stored in your gastrointestinal system, which has many cells that respond to serotonin. Higher serotonin levels in this area can upset your stomach and cause nausea.
Serious side effects
Suicidal thoughts or attempts
Young people aged 24 and under have a higher risk of suicidal thoughts and behaviors, especially in the first few months of starting an SSRI like Lexapro® or after a dose change. The exact reason for this is not fully understood.
Studies show that for those under 18, there are 1.4% more cases of suicidal thoughts and behaviors compared to those on a placebo. For those aged 18-24, the increase is 0.5%.
Mania
Mania is a time of at least one week when a person has a big change in behavior that greatly affects their daily life.
Signs of mania include:
- Increased talkativeness and rapid speech
- Less need for sleep
- Racing thoughts and distractibility
- Upbeat and over-excited
- Mood swings, impulsivity & irritability
In clinical trials, only 0.1% of people taking Lexapro® experienced mania or hypomania compared to those on a placebo. However, if you have bipolar disorder, the risk of antidepressant-induced mania can be higher, ranging from 20-40%.
Before starting Lexapro®, it’s important you check for any personal or family history of bipolar disorder. Many people with bipolar disorder first show depressive symptoms, so you could have an underlying bipolar disorder.
Typically, manic symptoms from antidepressants appear within a few days to 2 weeks after starting the medication and usually resolve within 2 weeks after stopping it.
Seizures
Lexapro® hasn’t been tested in people with seizure disorders, but some cases of convulsions have been reported. Generally, the risk of seizures with antidepressants is low and mostly linked to very high doses or overdoses.
If you have a history of seizures or epilepsy, you may still be able to use Lexapro® safely with careful monitoring by your healthcare provider. Always be transparent with your provider about the medication you are taking.
Angle-closure glaucoma
Angle-closure glaucoma is a serious eye problem where pressure builds up quickly inside your eye because the fluid that keeps your eyes nourished can’t drain properly. SSRIs can cause your pupils to dilate (get larger), which can lead to the iris (the colored part of your eye) blocking the eye’s drainage system.
This blockage causes the fluid to build up, increasing eye pressure, and potentially leading to permanent damage if not treated quickly.
Angle-closure glaucoma often comes on suddenly and can cause severe symptoms, including:
- Intense eye pain
- Blurred or reduced vision
- Rainbow-colored halos around lights
- Nausea and vomiting
Increased risk of bleeding
Taking SSRIs like Lexapro® can raise your risk of unusual bleeding, especially if you’re also using aspirin, NSAIDs, antiplatelet drugs, or anticoagulants like warfarin. SSRIs increase serotonin levels in your brain by blocking its reabsorption, but they also block serotonin reabsorption in platelets—blood cells that help with clotting.
Serotonin helps platelets to stick together to form clots. When serotonin levels in platelets become low, they are unable to clot together, leading to a higher risk of abnormal bleeding.
Hyponatremia
Hyponatremia is a condition where the sodium levels in your blood get too low. This can sometimes happen when taking SSRIs like Lexapro®, especially if you have syndrome of inappropriate antidiuretic hormone secretion (SIADH), which causes the body to hold onto water and dilute sodium. Elderly people, females, and those on diuretics have a higher risk.
Symptoms of hyponatremia include:
- Headache
- Trouble concentrating
- Memory problems
- Confusion
- Weakness and unsteadiness which may lead to falls
In more severe cases, it can cause hallucinations, fainting, seizures, coma, or even life-threatening issues.
Hyponatremia related to SSRIs usually starts within the first two weeks of treatment and is not related to the dose. Sodium levels normally return to normal within 2–20 days after stopping the medication.
Serotonin syndrome
Serotonin syndrome is a serious condition that can be life-threatening. It happens when there’s too much serotonin in your brain, often due to taking medications that boost serotonin levels, especially if you’re using more than one such medication. It can also occur if you’re on a medication that affects how serotonin is broken down, like MAOIs, which prevent serotonin from being used up or removed properly.
Keep an eye out for these symptoms of serotonin syndrome:
- Agitation, hallucinations, confusion, or delirium
- Fast heart rate or increased blood pressure
- Sweating and/or high fever
- Stiff muscles or tremors
- Seizures
- Nausea, vomiting, and/or diarrhea
When to seek medical help
If you have any new or worsening symptoms while taking Lexapro®, let your healthcare provider know right away. This includes common side effects like trouble sleeping, sexual issues, sweating more than usual, and feeling fatigued or nauseous. Your healthcare provider can help manage these side effects and adjust your treatment if needed.
For serious side effects, such as thoughts of self-harm, symptoms of mania, seizures, sudden vision problems, unusual bleeding, or signs of serotonin syndrome—seek emergency care immediately.
Find your Lexapro® support system with Lemonaid Health
While side effects from Lexapro® can occur, staying in communication with your healthcare provider is the best way to help you manage them effectively. Side effects often improve over time, but if you experience anything serious, seek help immediately. It’s important to inform your healthcare provider about any side effects you notice.
Our team at Lemonaid Health can help. Set up a virtual visit with a qualified US-based health professional who can help you understand any side effects and find appropriate solutions, including FDA-approved medication in clinically indicated cases.
Lexapro® is a registered trademark of H. Lundbeck A/S.
