Escitalopram
A widely used once-a-day antidepressant for depression and anxiety disorders. Usually well tolerated. Slow to start, so patience is part of the prescription.
Quick answer: The most common side effects of escitalopram are headache and nausea. Poor sleep, sweating, sexual problems and weight gain are also common, and early side effects usually fade. It’s a once-a-day SSRI antidepressant for depression and anxiety, with benefit starting in 2–4 weeks. Stop it slowly with your doctor, and get help urgently for thoughts of self-harm.
At a glance
- For
- Depression, generalised anxiety, panic disorder, social anxiety, OCD
- Works
- About half of people with depression improve a lot, compared with about a third on a dummy treatment. One of the better-tolerated options
- Cost
- Under the $25 PBS co-payment, about $21–24 for generics (brand premium extra); $7.70 concession
- Kicks in
- First benefit in 2–4 weeks; full effect by 6–8 weeks
- Taken for
- Usually at least 6–12 months after feeling well
- Watch for
- Nausea, headache, sweating, sleep changes, sexual side effects
Side effects tend to turn up in week one and benefits in week three. Annoying timing, but early side effects usually fade.
Brand names
- Lexapro, Esipram, plus generic brands sold as escitalopram
How it works
A selective serotonin reuptake inhibitor (SSRI): it stops nerve cells soaking serotonin back up, so more is available to carry signals.
Used for
- Major depression (TGA-approved)
- Generalised anxiety disorder, panic disorder, social anxiety disorder and obsessive-compulsive disorder (TGA-approved)
Side effects
Full side-effect list (from the product information)
How often, from the official product information. Bold = serious.
Very common more than 1 in 10
- Headache
- Nausea
Common 1 in 10 to 1 in 100
- Poor sleep, drowsiness, dizziness
- Tingling, tremor, vivid dreams
- Anxiety, restlessness
- Sexual problems (desire, orgasm, erection)
- Diarrhoea, constipation, vomiting
- Dry mouth, sweating, yawning
- Aches, tiredness, fever, sinusitis
- Appetite change, weight gain
Uncommon 1 in 100 to 1 in 1,000
- Teeth grinding, agitation, panic
- Confusion, fainting, fast heartbeat
- Ringing ears, taste or vision changes
- Bowel bleeding, nosebleeds
- Rash, itch, hives, hair loss
- Heavier or irregular periods
Rare 1 in 1,000 to 1 in 10,000
- Anaphylaxis
- Aggression, hallucinations or feeling detached
- Serotonin syndrome
- Slow heart rate
Frequency not known reported, rate unclear
- Low sodium, low platelets, bruising
- Bleeding after birth
- Suicidal thoughts, mania
- Seizures, abnormal movements
- Long QT, dangerous heart rhythms
- Hepatitis, angioedema
- Urine retention, prolonged erection
Get help urgently if
- Fever, sweating, shaking, muscle jerks, confusion or a racing heart (possible serotonin syndrome)
- Thoughts of suicide or self-harm: Lifeline 13 11 14, or 000
- Fainting, a racing irregular heartbeat, or bleeding from the bowel
Good to know
- Heart rhythm (QT): risk rises with dose. Maximum 20 mg, or 10 mg if over 65. Avoid other QT-prolonging medicines.
- Serotonin syndrome is more likely with tramadol, triptans, St John’s wort or other antidepressants. Never use with an MAOI. Bleeding is more likely with anti-inflammatories, aspirin or blood thinners.
- Stopping: taper over at least 1 to 2 weeks to avoid dizziness, “brain zaps” and poor sleep. Low sodium is more likely in older people.
- Under 25s: suicidal thoughts can increase early on or after a dose change. Thoughts of self-harm: see your doctor now or call Lifeline 13 11 14.
Support lines
If you or someone else is in danger right now, call your emergency number. To talk to someone, any time:
- Australia: Lifeline 13 11 14 (24/7, or text 0477 13 11 14), Suicide Call Back Service 1300 659 467, Beyond Blue 1300 22 4636, 13YARN 13 92 76 for Aboriginal and Torres Strait Islander people. Emergency: 000.
- Young people in Australia: Kids Helpline 1800 55 1800 (24/7, ages 5 to 25) or headspace (ages 12 to 25).
- New Zealand: call or text 1737. Emergency: 111.
- UK and Ireland: Samaritans 116 123. Emergency: 999 (or 112).
- US and Canada: call or text 988. Emergency: 911.
- Anywhere else: findahelpline.com lists free helplines in more than 100 countries.
Common questions
How long does escitalopram take to work?
Benefit usually starts after 2 to 4 weeks, with full effect by 6 to 8 weeks. Side effects like nausea often come first and usually fade.
Does escitalopram cause weight gain?
Appetite change and weight gain are listed as common side effects (between 1 in 10 and 1 in 100 people). Nausea and headache are the most common.
How do you stop escitalopram?
Reduce it slowly with your doctor, over at least 1 to 2 weeks, to avoid dizziness, “brain zaps” and poor sleep.
Information only. Not a recommendation or endorsement of any product. Whether a medicine suits you depends on your health and other medicines, so talk to your doctor or pharmacist. In an emergency, call 000 (Australia) or your local emergency number. From a mobile, 112 works in most countries.
More information
- Cipralex 10 mg SmPC (UK)
- Healthdirect: Medicines information
- Lifeline: 13 11 14
- Cipriani et al. 2018: Comparing 21 antidepressants (The Lancet)
- PBS: Escitalopram 10 mg
maladywise.com/medicines/escitalopram/