Part 1: Indications, efficacy, dosage, titration, discontinuation, pros and cons, adverse events, availability and how supplied.

> Lexapro (escitalopram) Review


The Lexapro (escitalopram) Overview is a briefer, more consumer-friendly version of this article. The information in this article comes from twelve separate pages, with more explanatory material, to which the overview links. The title of each section on both pages of this article is also a link to each of those pages.

Click here for Part 2: Warnings, clinical pharmacology, interactions, additional comments and consumer experiences

Abstract

Consumers need more information than what is provided in the patient information literature, but are intimidated by, or have no desire to read all of, the prescribing information for a drug. This review of the drug Lexapro (escitalopram) provides what the educated consumer wants, highlighting its use as, and comparing it with other Antidepressants. Also discussed are off-label uses, efficacy, adverse events and how to mitigate them, titration and discontinuation schedules, clinical pharmacology, other aspects of using Lexapro (escitalopram), and consumer experiences.

Classification

Primary Drug Class

Lexapro (escitalopram) is in the Antidepressants class of medications.

Additional Drug Categories

Serotonin-Selective Reuptake Inhibitors, Anxiolytics/Anti-anxiety

Indications

A review of Lexapro’s prescribing information, the literature, and consumer experience. Regarding off-label applications: if something is to be considered as “clinically significant” there need to be large, double-blind studies or clinical trials in addition to lots of consumer experiences, otherwise it will still be considered as experimental.

FDA-Approved Indications

  • Major depressive disorder (MDD) in adults
  • MDD in adolescents (Prozac is the only other modern antidepressant approved to treat MDD in adolescents)
  • Generalized anxiety disorder (GAD) in adults.

Drugs sometimes have different approvals in different countries.1 Consumers want to know this if they are running out of treatment options; or if they are researching their treatment options they may wish to know if, and why, a medication is approved for something in the US but not anywhere else.

Approved Uses Outside of the US

* Everywhere else in the world where you find Lexapro / Cipralex / etc. (escitalopram), it’s approved to treat social anxiety disorder and panic disorder, with or without agoraphobia, along with MDD and GAD.
  • Cipralex / Lexapro is also approved to treat OCD in:
    • Argentina
    • Australia
    • Canada
    • Chile
    • Denmark
    • Sweden
    • Spain
    • New Zealand
    • the UK

Clinically Significant or Otherwise Common Off-Label Uses

* Social anxiety disorder (SAnD) - it’s OK; sucking less than most other meds is Lexapro’s biggest advantage.

Less Common/Experimental Off-Label Uses

* Impulsive-compulsive Internet Usage Disorder. IC-IUD is better known as “Internet addiction,” and it’s real. The big question is: if you found this page when searching for Internet addiction, Internet usage disorder, or something similar, do you have IC-IUD, cyberchondria, or both? And if it’s both, should you take a medication for it? Lexapro seems to help with IC-IUD, talk therapy combined with workbooks is still your best bet for cyberchondria.

Failed off-label uses

  • Fear of public speaking. When you have no brain cooties. It didn’t just fail, Lexapro made it worse! Why someone thought taking an SSRI as required would be a good idea is beyond me. But either they don’t know how to write an abstract, or how SSRIs work, as the conclusion contradicts the title.
  • Kleptomania. In all fairness, nothing seems to work for kleptomania. A woman who was in the lock ward with me had been undergoing ECT for a month to treat kleptomania, and she was still stealing stuff.

Potentially dangerous off-label uses

Efficacy & Comparisons with Other Antidepressants

A review of prescribing information, the literature and consumer experiences. In addition to review sites, which don’t skew as negative as one would think, consumer experiences with medications are frequently reported on social media sites that have nothing to do with medications or illnesses. There is such a consistent overlap in many demographics (e.g. women with bipolar 2 and/or migraines and scrapbooking) to provide a great deal of data on efficacy and adverse reactions from a very natural environment where consumers discuss their conditions and how to treat them that is free of almost all prejudices regarding medications and other treatment options.

Onset of Action

Lexapro can start working within one week. As usual there are conflicting data. All the reports from people who’ve taken Lexapro that I’ve read (anecdotal evidence) indicate that Lexapro often starts working in the first week or two.

You should still give it at least three weeks, unless the side effects hit hard, fast, and don’t start getting better within two weeks of reducing the dosage (if there’s any room to reduce the dosage).

Efficacy for its Approved Indications

Major Depressive Disorder (MDD)

The odds are pretty good that Lexapro will work for MDD, as in you have a 60–75% chance that you’ll respond to Lexapro2 - i.e. it will do something positive - and a 60–70% chance of remission, i.e. your MDD symptoms will more-or-less go away and stay away, although you may have to keep taking your meds to ensure you stay symptom-free.
Keep in mind that:

  1. Serotonin reuptake inhibition, and everything else SSRIs do, is not the answer for everyone, either by itself or at all.
  2. When you pool all the data together (see below) you’ll find that Celexa and Lexapro are better than the other SSRIs. It’s marginally statistically significant for everyone who still takes the other SSRIs. Their real advantage comes from sucking less than the others and being better at preventing relapses, so if you and your doctor think you’re going to be depressed forever without meds, you’re way better off with Celexa or Lexapro than another SSRI or other antidepressant.
  3. We can’t hammer this point home as hard or often enough: antidepressants work only for people who are seriously depressed.3

Like most SSRIs the clinical trials published in the PI sheet used a ridiculously small set of people with vague results. How small? The usually don’t print the number of patients, that’s how small. Things are different in Canada, where some actual numbers are published in the PI sheet. But it tells us only that people felt somewhat better, and not how many of them did.

Unlike most antidepressants I was actually able to find the clinical trials on PubMed, although there are no more data in the abstracts than in the PI sheet. Except for Fixed-dose trial of the single isomer SSRI escitalopram in depressed outpatients. The discrepancies between the PI sheet and the abstract that are really telling. The US PI sheet, which doesn’t allow you to copy any text, has the typically vague result of “statistically significant greater mean improvement compared to placebo on the MADRS.” But when you look at the study:

Clinical response was evaluated by the Montgomery-Asberg Depression Rating Scale (MADRS), the 24-item Hamilton Rating Scale for Depression (HAM-D), the Clinical Global Impressions (CGI) scales, the Hamilton Rating Scale for Anxiety (HAM-A), and patient-rated quality-of-life scales.
RESULTS: Escitalopram, at both doses, produced significant improvement at study endpoint relative to placebo on all measures of depression; significant separation of escitalopram from placebo was observed within I[sic] week of double-blind treatment. Citalopram treatment also significantly improved depressive symptomatology compared with placebo; however, escitalopram, 10 mg/day, was at least as effective as citalopram, 40 mg/day, at endpoint. Anxiety symptoms and quality of life were also significantly improved by escitalopram compared with placebo. The incidence of discontinuations due to adverse events for the escitalopram 10 mg/day group was not different from the placebo group (4.2% vs. 2.5%; p = .50), and not different for the escitalopram 20 mg/day group and the citalopram 40 mg/day group (10.4% vs. 8.8%; p = .83). Cipralex Canadian Product Monograph

Note how more scales are mentioned in the abstract. The PI sheet omits two points that numerous studies will repeatedly prove: while Lexapro usually doesn’t work any better than Celexa, it often does work faster than Celexa, or any other SSRI.

The Australian PI sheet confirmed that the clinical trial about preventing the relapse of depression symptoms I found before is indeed the one in the PI sheet. It, too, is pitifully small (181 taking Lexapro, 93 taking placebo), but at least it had everyone taking their pills for nine months. Close to 75% of the people taking Lexapro after 36 weeks were still not depressed, vs. 60% taking the wonder drug Placebo.

You’re probably a lot less likely to commit suicide when taking Lexapro than taking a placebo. But is that really a big surprise? I guess it is to some people.

There have been studies experimenting with dosages up to 50mg(!) a day. This is the first time I’ve read a Lundbeck-sponsored study of Lexapro where there has been a significant number of people quitting due to side effects (20%). 30mg could be a dosage to consider, especially if you know or suspect you’re a rapid or ultra-rapid metabolizer of drugs cleared by CYP2D6 (substrates), or you take a drug that induces CYP2D6, like Tegretol (carbamazepine). 40mg seems to be the upper limit of real efficacy.

Predicting if a med will work for you is something that can be really useful. What have we got for Lexapro…

Generalized Anxiety Disorder (GAD)

The story for anxiety disorders is a bit better. People in the Panic/Anxiety community love Lexapro. Like MDD efficacy rate is still around 70–75%, but as GAD (and many of the other anxiety disorders for which it’s used off-label) tends to respond at lower dosages than MDD, the side effects tend to suck a lot less than GAD and other treatments.

In regards to GAD, this double-blind study of 158 people taking Lexapro vs. 157 people taking placebo had 68% of the people taking Lexapro responding against 41% taking the placebo. Not too bad for the placebo. In Lexapro’s favor, though, on the Hamilton Rating Scale for Anxiety, those taking Lexapro averaged a 11.3 point drop from a score of 18 points or higher, whereas those taking the placebo dropped only an average of 7.4 points. So you can fool some of the people with GAD into feeling better, but even those you fool won’t feel better than they could have with a real med.

What looks like a follow up to the clinical trials for Lexapro’s approval for GAD has even better numbers than the above. Those who completed the 8-week double-blind trials were given the option of knowing they were taking Lexapro (escitalopram oxalate) 56% of the people made it to the end, so about half in all, or roughly 250 people were still helped by Lexapro (escitalopram oxalate) for generalized anxiety disorder (GAD), and helped a lot.

Just like with MDD, Lexapro helps to prevent the relapse of generalized anxiety disorder. At least when compared with placebo. After taking Lexapro for 8–12 weeks:

For Off-Label Applications

Panic-Anxiety Disorders other than GAD

Except for hoarding, where you’ll want Paxil, Lexapro may as well be approved for the rest of them. Oh, wait, Lexapro is approved to treat other anxiety disorders, just not in the US. We really need a way to streamline the approval process for meds when they’re already available here and approved for something else in practically every other country on the planet. In any event…

Lexapro versus Other Antidepressants for Approved Indications

Lexapro vs. Celexa

Lexapro vs. Celexa. This is one of the most asked questions we get when it comes to comparing meds, and it should be. Is there a real difference in efficacy between Lexapro and Celexa?

  • Sort of, but not by much.
  • Even though Lexapro works faster the real difference is in the long run, because Lexapro sucks a little less. So more people will take Lexapro for a longer time, but the difference is such that it matters only to individuals and national healthcare systems, and not HMOs and insurance companies. Which is why generic citalopram is covered while still-expensive escitalopram isn’t.
  • Is it worth switching from Celexa to Lexapro? If you’re thinking about it then it’s worth talking to your doctor about it, but it’s probably not worth arguing with either whoever prescribes it or pays for it.
  • But if you haven’t started on either, and Lexapro is an option that won’t cost much more than Celexa, go for the Lexapro.
  • Let’s see what the science says:
    • Cipralex vs. Cipramil in outpatients with depression. A Lundbeck-sponsored trial. 20mg of Cipralex/Lexapro vs. 40mg of Cipramil/Celexa. The results: Lexapro worked better (76% response rate, 61% remission rate vs. 56% and 43% for Celexa), and while both didn’t suck all that much, Lexapro sucked even less (4 out of 138 quit taking Lexapro due to side effects vs. 9 out of 142 for Celexa).
    • Cipralex vs. Cipramil for depression treated by primary care physicians. Another Lundbeck-sponsored trial. 10mg of Cipralex/Lexapro vs. 20mg of Cipramil/Celexa. The results: A little odd. At the end of 8 weeks Lexapro had a 63% response rate and 55% remission rate vs. Celexa’s 55% and 45%, by week 24 Lexapro had an 80% response rate and 76% remission rate vs. Celexa’s 78% and 71%. The odd part is both meds were way more effective for the moderately depressed than the severely depressed at week 8, and Lexapro was barely more effective for the moderately depressed at week 24. This runs counter to all the studies showing meds to be more effective for the severely depressed. But there are always studies with atypical results.
    • Lexapro vs. Celexa vs. Effexor for efficacy and cost of treating depression. Britain’s NHS undertook this study. The results: Lexapro “dominates” Celexa and Effexor. That’s what they wrote. Lexapro “just dominates” Effexor.
    • Lexapro vs. Celexa vs. Effexor for efficacy and cost of treating depression. Just like the above study, only in Spain. They also use the term “dominant.” Otherwise Lexapro had a higher remission rate than Celexa and Effexor (58% vs. 38% vs. 32%), otherwise there wasn’t much difference between Lexapro and Celexa. Both were better than Effexor.
    • escitalopram vs. citalopram vs. sertraline for Unipolar Major Depression. 10–20mg of Lexapro vs. 20–40mg of Celexa vs. 50–150mg of Zoloft. The results: holy shit! 97% response rate for Zoloft vs. 90% for Lexapro vs. 86% for Celexa!?! Oh, wait, the trial was sponsored by Torrent pharmaceuticals. The real winners were the researchers. I’m taking this one with a shaker of salt.
    • Lexapro vs. Celexa - which is worse to overdose on? This is actually an interesting question, as only critters have been given more than 60mg of Lexapro. Does the two-to-one dosage ratio of Celexa to Lexapro hold up when you take an entire bottle? How much difference does the r-enantiomer of Celexa make? The results: Celexa is more toxic than Lexapro, but, like all SSRIs, it’s next to impossible to kill yourself with them. Although the median dosage of Celexa was higher (310mg vs. 130mg for Lexapro. The equivalent dosage of Celexa would be 260mg.), it’s hard to tell by how much that skewed the results. The most striking was the incidence of seizures, 30 for Celexa vs. 1 for Lexapro.
    • Is escitalopram really relevantly superior to citalopram in treatment of major depressive disorder? A meta-analysis of head-to-head randomized trials. This analysis of Lundbeck’s clinical trials, and some of the studies and trials listed above, calls statistical shenanigans. Their main concerns: Over-reliance on the bullshit MADRS - see the page on psych tests for more info - and disputing claims of statistical significance. I’ll leave the latter up to people with better stat chops than I have. As this is the full text and the full text is available for several of the referenced papers, you can compare them all yourself.
    • Escitalopram: superior to citalopram or a chiral chimera? This analysis also calls statistical bullshit on Lundbeck’s claims that Lexapro is superior to Celexa.
    • This analysis looked at the same data and thought it all looked good.

Lexapro vs. Other Meds for Major Depression (MDD)

Lexapro for GAD

For Off-Label Uses

  • Lexapro vs. Paxil for Social Anxiety Disorder (SAnD). This Lundbeck-sponsored study isn’t very fair, as it compares 20mg of the older, immediate-release Paxil against 5mg, 10mg, and 20mg of Lexapro. While 20mg of immediate-release Paxil is GSK’s recommendation for SAnD, it’s 25–37.5mg a day for the controlled-release flavor. While 10mg of Lexapro is equal to 10mg of Paxil, 20mg of Lexapro is more like 37.5mg of Paxil CR. So it’s not all that surprising that 20mg of Lexapro was more effective than 20mg of Paxil.
  • Lexapro vs. Celexa vs. Placebo for Panic disorders. Panic disorders are off-label for Celexa as well. The results - Lexapro and Celexa are both really good for panic, and Lexapro sucks less than the placebo. This sort of thing shows up in a lot of Lexapro studies and clinical trials: “The rate of discontinuation for adverse events was 6.3% for escitalopram, 8.4% for citalopram, and 7.6% for placebo.”
  • Lexapro vs. Celexa vs. Placebo for Panic disorders - the sequel. The results - Lexapro kicked Celexa’s ass, which is something you don’t see very often. This was done by DJ Stein, who is one of Lundbeck’s favorite researchers, so he could have set it up to slant things in Lexapro’s favor. The abstract isn’t very forthcoming in results:

Treatment with escitalopram was associated with significant improvement on all 5 subscales of the P&A. Citalopram was significantly different from placebo in 3 subscales. […] Escitalopram was superior to placebo on 12 of 16 items of the Q-LES-Q, while citalopram was superior on 7 items.”

Unlike Dr. Stahl’s study above, there’s no hint in the abstract as to what “significant” means.

 


These are not prescribing guidelines per se. For consumers they are an antidote to the direct-to-consumer marketing phrase “Talk to your doctor about…” regarding the advertised drug. For physicians they are likewise an antidote to drugs being pushed on them by pharm reps.

A synthesis of the literature and consumer experiences can provide good rules of thumb as to when consumers should and should not talk to their doctors, and when doctors should and should not talk to their patients, about particular drugs the first time they discuss treatment options. If at all.

Why/When Lexapro (escitalopram) Should Be Recommended

You haven’t tried any antidepressant before, you and your doctor both think you need one, your symptoms don’t scream Wellbutrin (anhedonia, unable to conceive on how to begin anything), but are still pretty bad and you need something to work sooner than later. And your insurance will pay for it.

Why/When Lexapro (escitalopram) Should Not Be Recommended

If Celexa didn’t work for you, or Celexa is working for you with side effects that really aren’t as bad as you think they are.

The only side effects that are less likely to be problems with Lexapro than Celexa are drowsiness and weight gain. The key phrase being less likely. The good news is switching back to Celexa if Lexapro doesn’t work for you is less likely to result in SSRI poop-out or becoming treatment-resistant when neither of those would have happened if you just stayed with Celexa. The bad news is “less likely to” does not equal “won’t.”

Dosage, Titration, and Discontinuation

A review of Lexapro’s prescribing information, the literature, and consumer experience. We have found that for most consumers in an out-patient situation the titration schedule published in the prescribing information is often too aggressive. Many would often be better served by starting at a dosage lower than recommended by the manufacturer and, instead of a fixed target dosage, the dosage where symptoms are controlled within a given range is the goal. Patients could adjust their dosage as needed without having to schedule an appointment with their prescriber.

Dosage and Doses

One 5–10mg (or 15 or 20mg) tablet once a day.

Dosing Schedule

Like all SSRIs you’ll have to figure out for yourself if taking Lexapro in the morning or at night works better. Start with taking it in the morning and give it at least a week before switching to taking it at night if it makes you too drowsy, as the drowsiness could be a short-term side effect. Most people find Lexapro to be “activating” (i.e. it has a mild stimulant effect) than sedating.

Titration Schedule

The official titration schedule from Forest for all applications: Start at 10mg once a day, that’s it. There’s no benefit to taking 20mg a day, and there’s no 15mg tablet. At least if you live in the United States.

If you look at some of Lexapro’s PI sheets from other countries you’ll find that Lundbeck (the original developers, or pioneering company) recommends going up to 20mg if required. In Canada they recommend decreasing the dosage to 5mg if the side effects seem to be too harsh, and in Israel they recommend starting at 5mg for panic disorder.

We say: Start at 5mg a day. At least we agree that the dosage should be increased only if needed.

There have been studies experimenting with dosages up to 50mg(!) a day. This is the first time I’ve read a Lundbeck-sponsored study of Lexapro where there has been a significant number of people quitting due to side effects (20%). 30mg could be a dosage to consider, especially if you know or suspect you’re a rapid or ultra-rapid metabolizer of drugs cleared by CYP2D6 (substrates), or you take a drug that induces CYP2D6, like Tegretol (carbamazepine). 40mg seems to be the upper limit of real efficacy.



One aspect of taking a medication that is frequently missing from patient information, as well as prescribing information, is how to stop taking it. Consumers are left with nothing more than the warning to not stop taking their medication without first talking to their doctor. Circumstances do not always allow for that. Many consumers feel better if they have the knowledge about what they should do.

How to Discontinue

Decrease your dosage by 5mg every week. So if you’re taking 10mg a day, take 5mg for a week, then you can stop. If you’re at 5mg a day then you should be OK.
Like Celexa, Lexapro has a long half-life, as far as SSRIs & SNRIs are concerned. So discontinuing Lexapro tends to be a lot easier than most other SSRIs.

If you do have the symptoms of SSRI discontinuation syndrome you can always cut 5mg tablets in half and take one of those each day for a week.

If you’ve been splitting 10mg tablets to save money you and your doctor will have to figure out which is going to suck the least: staying on Lexapro until you can fill a prescription for 5mg tablets or the oral solution, putting up with the discontinuation syndrome, or trying to quarter 10mg tablets.

Discontinuation Symptoms

The usual for SSRIs/SNRIs. Dizziness, numbness and tingling in your extremities (paraesthesias), electric shock sensations (brain zaps), agitation, anxiety, impaired concentration, headaches (comparable to migraines, actual migraines if you’re susceptible to them), tremors, nausea, vomiting, and excessive sweating.

Notes, Tips, etc. About Discontinuing Lexapro

As mentioned above, the oral solution allows you to taper off as slowly as you need to.

And there’s always the old standby for severe SSRI/SNRI discontinuation syndrome: a prescription for generic Prozac (flouxetine). One to two weeks at 10mg a day is usually enough to take the edge off, if not completely get rid of, the discontinuation symptoms for any med. Prozac also has an oral solution, one that doesn’t taste too bad (it’s like a good, mint-flavored mouthwash with the consistency of cough syrup).

Pros, Cons, and Interesting Information

Even though they want more information than the patient information literature provides, consumers also want a very high-level synopsis. A synthesis of the prescribing information, the literature, and consumer experience provides the pros and cons of using Lexapro (escitalopram) for its approved indications and clinically-significant or otherwise common off-label uses.

Pros

Lexapro works faster than other SSRIs. Many people who take Lexapro have reported that it has better effects and lower chances for side effects than other SSRIs (especially weight gain), and when side effects do strike most of them tend to be less harsh. Fewer drug-drug interactions than any other SSRI.

Cons

Few dosage options with the tablets. Some side effects (teeth grinding, TMJ, anorgasmia) can be way worse than with other SSRIs, and those first two can get really painful.


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When doing their own research about a medication, the educated consumer, and perhaps medical students and healthcare professionals may find interesting pieces of information that are rarely discussed in a prescriber-patient setting. Such information may be rarely discussed because it is trivial, but many people tend to remember interesting, albeit trivial information about something along with other information associated with it. There may be something here to get a patient to remember a more important point about a medication. The other side of that mnemonic coin is what a medication is best known for, something a drug-naïve consumer might not know. While prescribers don’t always assume their patients are aware of a drug’s trait that is “common knowledge,” consumers who do some research don’t want to feel like idiots. They want to know something that isn’t misinformation. Prescribers can always couch questions about well-known traits in forms like “You’re aware that Panacea can cause significant giddiness, right?”

Interesting Things Doctors Rarely Tell Their Patients

Lexapro is the only true SSRI. All the others affect one or more other neurotransmitters to some extent, although only enough for side effects, off-label uses, or as the reason why only one SSRI works for somebody.

What Lexapro (escitalopram) is Best Known for

The Lexapro Yawn. It doesn’t matter that you’re not tired. Lexapro can make you yawn so intensely and so often that your jaw can pop out of its joints and you’ll need to see a doctor about that.
I’m sorry if reading this made you yawn, especially if you take Lexapro.

Noted Traits & Effects

Adverse Events

A review of prescribing information, the literature, and consumer experiences. One thing this review has found is no matter which neurological/psychiatric drug someone takes, one or more of these adverse events will happen and usually be gone, or at least will diminish to the point where they are barely noticed, within a week or two.

  • Headache
  • Drowsiness/fatigue - even when taking stimulants in some circumstances.
  • Insomnia, instead of or alternating with the drowsiness.
  • Nausea
  • Assorted other minor GI complaints (constipation, diarrhea, etc.)
  • Generally feeling spacey / out of it
    • Which can all add up to the ever-helpful ”flu-like symptoms” listed as an adverse event on the PI sheet of practically every medication on the planet used to treat almost any condition humans and other animals could have.
  • Will affect dreams. There is no way of telling if that will be good or bad, the extent of the change, let alone if this side effect is permanent or temporary.

Potential side effects are often used as a rationalization to not take a medication, and that is a valid reason why prescribers don’t like their patients looking up medications on The Internet. It’s a delicate balancing act between providing too little or too much information about side effects. What may be contrary to popular belief, reports of side effects from consumers on sites run by either medical professionals or consumers themselves are generally not too far outside what is published in the literature after a drug has been on the market.

Common Adverse Events

The usual for SSRIs:
  • headache
  • nausea
  • dry mouth
  • sweating
  • sleepiness or insomnia (with insomnia more likely)
  • diarrhea or constipation
  • assorted sex problems

Weight gain is a lot less likely than with other SSRIs and all of the typical side effects tend to be milder. The most likely sexual side effect is anorgasmia , i.e. you can’t come, no matter how much romance and/or porn is involved. In the prudish language of PI sheets and clinical trials, anorgasmia affects only women. With men the problem is listed as an “ejaculation disorder .”

Uncommon Adverse Events

Potentially Dangerous Adverse Events

and Heart arrhythmia problems like torsades de pointes (TdP)/prolonged QT interval (QTc). This happens more often than I had originally thought, as both Celexa (citalopram) and Lexapro are on the list of drugs to totally avoid if you have a history of TdP/QTc/cardiac arrhythmia.

These will stick around longer than AD side effects. More ways to be stuck-up at Straitjacket T-shirts. All stickers only $5
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Never underestimate the value of gallows humor when confronted with a condition that comes with the dual stigmata of having a mental illness or other neurological disorder and treating it with a medication that everyone from family members to movie stars and other misinformed celebrities say is worse than the condition itself. It’s not for all consumers, but those who have been using the Internet most of their lives generally appreciate it.

Freaky Rare Side Effects:

Ways to counter / minimize / mitigate / deal with some side effects

Names, Availability, Brand vs. Generic Issues, Forms

Consumers not only travel, they often live in other countries for extended periods. Thus they need to know if the medications they take are available in those countries, what trade names are used, and if the less-expensive generic version is available.

Available as Lexapro in these countries

Argentina, Australia, Brazil, Chile, Colombia, Hong Kong, Ireland, New Zealand, Peru, Philippines, Singapore, Thailand

Other trade name(s) for Lexapro used in these countries

  • Cipralex: EU, Iceland, India, Israel, Norway, UK
  • Cipralexia: Finland
  • Cipralexin: Finland
  • Seroplex: France
  • Sipralexa: Belgium, Luxembourg

Generic Name and Availability

US Generic name/INN:escitalopram
US Generic available?Yes

escitalopram is available in these countries4

Australia, Argentina, Canada, Chile. Either pending in the EU or available in some EU member states, such as Spain.

Branded Generic Names5 & Transcribed or Transliterated INN/Generic Name6

  • Argentina: Esertia, Meridian
  • Australia: Esipram, Esitalo, Lexam, Loxalate
  • Chile: CELTIUM, ECIPRAX, ECTIBAN, IPRAN, NEOPRESOL, NEOZENTIUS, REPOSIL, ZEPAZ Comprimidos
  • Spain: Esertia
  • essitalopraami is Finnish for escitalopram

Not all generic medications are created equal. Consumers have noted differences in the quality of medications produced by different manufacturers. See the article on on the differences between brand and generic medications for more information.

Specific generics with complaints, or preferred generics manufacturers

We’re already getting reports of people having problems with Mylan’s generic for Lexapro, one of the two (so far) escitalopram oxalate tablets available on the US market.

Keep an eye on the topic linked above, and any others that may be opened on our Brand vs. Generic forum, for additional details.

Generics with independently-tested bioequivalence

How Supplied

Available/Supplied As

5, 10, and 20mg tablets and oral solution in the US.

Most EU countries have both tablets and capsules, a 15mg tablet/capsule, and premeasured 1ml, 5ml, 10ml and 20ml dosages of the oral solution. There’s an orally dissoluble (Cipralex orodispersible) tablet available in Sweden and the UK.

Shelf Life

Tablets - 3 years. Oral suspension - 2 years, 1 month after opening.

Rate this article

If you feel like it, you may rate this article on a scale of 0 (worst) to 5 (best). The more value-judgments the better, even if you can criticize each only once.

Please rate Lexapro (escitalopram): a review of the literature and consumer experience.

0 stars Everybody hates me.


Click here for Part 2: Warnings, clinical pharmacology, interactions, additional comments and consumer experiences




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References

  1. Hughes, Shannon, and David Cohen. “Can online consumers contribute to drug knowledge? A mixed-methods comparison of consumer-generated and professionally controlled psychotropic medication information on the internet.” Journal of medical Internet research 13.3 (2011).
  2. Faught, Edward. “Topiramate in the treatment of partial and generalized epilepsy.” Neuropsychiatric disease and treatment 3.6 (2007): 811-821.
  3. Lexapro’s Full US Prescribing Information
  4. Mosby’s Drug Consult 2007 (Generic Prescription Physician’s Reference Book Series) © 2007 ISBN:978-0323040587
  5. Article I, Section 8 of the US Constitution
  6. Greenstone Pharmaceuticals’ Product List. Greenstone LLC Last accessed 04 July 2014
  7. History of Pfizer and Warner-Lambert; 2000 to Present. Pfizer.com Last accessed 04 July 2014

{{$$bigbiblio}}


1 Before Cymbalta (duloxetine) was approved as an antidepressant in the US it was already approved in the EU, but only for stress urinary incontinence and sold under the trade name Yentreve. Duloxetine is now sold in the EU as an antidepressant under the trade name Cymbalta.
A better known, if slightly different example is bupropion. According to the 2007 edition of Mosby's Drug Consult, and my highly-skilled Google-fu, in the US, Canada and Singapore you can get both Wellbutrin (bupropion) as an antidepressant or as Zyban (bupropion) to stop smoking. In Korea, Thailand and most of South America (but not Brazil) you can get bupropion (under various trade names) only as an antidepressant. In Brazil, the EU & UK, Israel, India, Australia and New Zealand it's only available as Zyban to help you stop smoking.

2 The data are often contradictory when compared with Celexa. Celexa averages 60-70% for both response and remission, while Lexapro is often in the neighborhood of 70-75%; hence the big spread on the response rate that seems a bit low given the results of a lot of studies, trials, and anecdotal evidence.

3 Most of the time at any rate. There's always an outlier study or two, as you'll see if you keep reading this page.

4 Generic availability isn't fully harmonized in the EU. Sometimes a drug is available everywhere as a generic, sometimes it's available only in a few member states. We'll provide the best information we have.

5 The term "branded generic" has three meanings:
1) A generic drug produced by a generics manufacturer that is a wholly-owned subsidiary of the company that makes the branded version. E.g. Greenstone Pharmaceuticals makes gabapentin, and they are owned by Pfizer, who also own Parke-Davis, the makers of Neurontin.
2) A branded generic is also a generic drug given a 'brand' name by the manufacturer (e.g. Teva's Budeprion), but otherwise has the same active ingredient as the original branded version (Wellbutrin).
3) A branded generic is also a generic drug given a 'brand' name by the manufacturer (e.g. Sanofi-Aventis' Aplenzin, which is bupropion hydrobromide) and uses a salt of the active ingredient that is different from the original branded version and other generics (Wellbutrin, Budeprion and all the others are bupropion hydrochloride). We aren't sure if that really makes a difference or not. The FDA says they're the same thing. As usual, the data are contradictory, but most evidence indicates that the FDA is right and the differences are negligible.
For our purposes a "branded generic name" refers to the second and third definitions. We'll note if any preferred generics are manufactured by the pioneering company's subsidiary.

6 In some countries the INN / generic name is transcribed into a local phonetic equivalent. In Spanish it's often so close as to be redundant (e.g. topiramato vs. topiramate). In Finnish it's close to being a different drug (e.g. escitalopram vs. essitalopraami). I can understand the need to transliterate the INN / generic name into another alphabet (topiramate becomes топирамат in Russian), but giving a med a different generic name using the Latin alphabet just makes it difficult to find.


If you have any questions not answered here, please see the Crazymeds Lexapro discussion board. We welcome criticisms of the articles, notifications of bad links, site problems, consumer experiences with medications, etc. I’m not always able to write back. Hence I never answer questions about meds via e-mail that are answered by this or other articles. Especially if they have been repeatedly asked on the forum. That’s why we write these damn things. Questions about which meds are best for your condition should also be asked on the forum; because this is a free site, so the price of admission is making things easier for somebody else searching for the same answer. We don’t deal with children on the forum or in private because after doing this for ten years I don’t have the emotional stamina to deal with kids who have brain cooties. How to contact Crazymeds. — Jerod Poore, CME, Publisher crazymeds.us


Last modified on Wednesday, 25 September, 2013 at 11:16:24 by JerodPoorePage Author Date created Sunday, 05 December 2010 at 13:49
“Lexapro Comprehensive Rundown Part 1″ by Jerod Poore is copyright © 2010 Jerod Poore Published online 2010/12/05
Citation options to copy & paste into your article:
Plain text:Poore, Jerod. “Lexapro Comprehensive Rundown Part 1.” crazymeds.us. (2010).
with Microdata: <span itemprop='citation'>Poore, Jerod. "Lexapro Comprehensive Rundown Part 1." <em>crazymeds.us</em>.(2010).</span>
Linked:<a href="http://scholar.google.com/citations?user=5rkux7sAAAAJ&hl=en&oi=sra">Poore, Jerod</a>. <a href='http://www.crazymeds.us/pmwiki/pmwiki.php/Meds/LexaproComprehensiveRundownPart1'>"Lexapro Comprehensive Rundown Part 1"</a>. <a href="http://www.crazymeds.us/pmwiki/pmwiki.php/Main/HomePage"> <em>crazymeds.us</em></a>. (2010).
with Microdata:<span itemprop='citation'> <a href="http://scholar.google.com/citations?user=5rkux7sAAAAJ&hl=en&oi=sra">Poore, Jerod</a>. <a href='http://www.crazymeds.us/pmwiki/pmwiki.php/Meds/LexaproComprehensiveRundownPart1'>"Lexapro Comprehensive Rundown Part 1"</a>. <a href="http://www.crazymeds.us/pmwiki/pmwiki.php/Main/HomePage"> <em>crazymeds.us</em></a>. (2010).</span>

Lexapro, and all other drug names on this page and used throughout the site, are a trademark of someone else.

will probably have the name of the manufacturer and trademark owner (they’re not always the same company) at or near the very bottom. Or ask Google who the owner is. The way pharmaceutical companies buy each other and swap products like Monopoly™ real estate, the ownership of the trademark may have changed without my noticing. It may of changed hands by the time you finished reading this article.




Page design and explanatory material by Jerod Poore, copyright © 2004 - 2014. All rights reserved.
Keep up with Crazymeds and and/or my slow descent into irreparable madness boring life. Pick your preferred social media target(s):

Almost all of the material on this site is by Jerod Poore and is copyright © 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, and 2014 Jerod Poore. Except, of course, the PI sheets - those are the property of the drug companies who developed the drugs the sheets are about - and any documents that are written by other people which may be posted to this site will remain the property of the original authors. You cannot reproduce this page or any other material on this site outside of the boundaries of fair use copying without the express permission of the copyright holder. That’s usually me, so just ask first. That means if want to print out a few pages to take to your doctor, therapist, counselor, support group, non-understanding family members or something like that - then that’s OK to just do. Go for it! Please. As long as you include this copyright notice and something along the lines of following disclaimer, I’m usually cool with it.



All rights reserved. No warranty is expressed or implied in this information. Consult one or more doctors and/or pharmacists before taking, or changing how you take any neurological and/or psychiatric medication. Your mileage may vary. What happened to us won’t necessarily happen to you. If you still have questions about a medication or condition that were not answered on any of the pages you read, please ask them on Crazy Talk: the Crazymeds Forum.
The information on Crazymeds pertains to and is intended for adults. While some information about children and adolescents is occasionally presented (e.g. US FDA approvals), pediatric-specific data such as dosages, side effects, off-label applications, etc. are rarely included in the articles on drugs or discussed on the forum. If you are looking for information regarding meds for children you’ll have to go somewhere else. Plus we are big pottymouths and talk about S-E-X a lot.
Know your sources!
Nobody on this site is a doctor, a therapist, or a pharmacist. We don’t portray them either here or on TV. Only doctors can diagnose and treat an illness. While it’s not as bad as it used to be, some doctors still get pissed off by patients who know too much about medications, so tread lightly when and where appropriate. Diagnosing yourself from a website is like defending yourself in court, you suddenly have a fool for a doctor. Don’t be a cyberchondriac, thinking you have every disease you see a website about, or that you’ll get every side effect from every medication1. Self-prescribing is as dangerous as buying meds from fraudulent online pharmacies that promise you medications without prescriptions.
All information on this site has been obtained through our personal experience and the experiences family, friends, what people have reported on various reputable sites all over teh intergoogles, the medications’ product information / summary of product characteristic (PI/SPC) sheets, and from sources that are referenced throughout the site. As such the information presented here is not intended as a substitute for real medical advice from your real doctor, just a compliment to it. You should never, ever, replace what a real doctor tells you with something from a website on the Internet. The farthest you should ever take it is getting a second opinion from another real doctor. Educate yourself - always read the PI/SPC sheet or patient information leaflet (PIL) that comes with your medications and never ever throw them away. OK, you can throw away duplicate copies, but keep at least one, as that’s your proof of purchase of having taken a med in case a doctor doubts your medical history. Plus they take up less space than a bottle, although keeping one inside of a pill bottle is even better.
Crazymeds is not responsible for the content of sites we provide links to. We like them, or they’re paid advertisements, or they’re something else we think you should read to help you make an informed decision about a particular med. Sometimes they’re more than one of those things. But what’s on those sites is their business, not ours.
Very little information about visitors to this site is collected or saved. From time to time I look at search terms used and which pages they bring up in an effort to make the information I present more relevant. And the country of origin, just because I’m geeky like that. That’s about it. Depending on how you feel about Schrodinger, our privacy policy should either assuage or exacerbate your paranoia.
Crazymeds is optimized for the browser you’re not using on the platform you wish you had. Between you and me, it all looks a lot cleaner using Safari or Chrome, although more than half of the visitors to this site use either Safari or Internet Explorer, so I’m doing my best to make things look nice for IE as well. I’m using Firefox and running Windows 72. On a computer that sits on top of my desk. With a 23 inch monitor. Hey, at least you can make the text larger or smaller by clicking on the + or - buttons in the upper right hand corner. If you have Java enabled. Like 99% of the websites on the planet, Crazymeds is hosted on domain running an open source operating system with a variety of open source applications, including the software used to display what you’ve been reading. As such Crazymeds is not responsible for whatever weird shit your browser does or does not do when you read this site3.
No neurologists, psychiatrists, therapists or pharmacists were harmed in the production of this website. Use only as directed. Void where prohibited. Contains nuts. Certain restrictions may apply. All data are subject to availability. Not available on all mobile devices, in the 12 Galaxies Guiltied to a Zegnatronic Rocket Society, or in all dimensions of reality. Hail Xenu!

‘Everything is true, nothing is permitted.’ - Jerod Poore


1 While there are plenty of books to help you with hypochondria, for some reason there’s not much in the way of websites. Then again, staying off of the Internet is a large part of curing/managing the disorder.

2 Remember kids, Microsloth operating systems are like TOS Star Trek movies with in that every other one sucks way, way more. With TOS Star Trek movies you don’t want to bother watching the odd-numbered ones. With Microsloth OS you don’t want to buy and install the even-numbered ones. Anyone who remembers ME and Vista knows what I mean.

3 Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas? I don’t even need my big-ass rant any more. Heartbleed has made my case for me. And that’s just the one that got all the media attention. The very nature of an open source operating system makes security as much of an illusion of anonymity. Before you flip out too much: the domain Crazymeds is hosted on uses a version of SSL that is not affected by the Heartbleed bug. That’s one of the many reasons why I pay a lot of money and keep this site on Lunarpages.

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