Highlighting uses, dosage, how to take & discontinue, side effects, pros & cons, and more


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Brand & Generic Names; Drug Classes

US brand name: Lexapro
Generic name: escitalopram

Drug Class(es)

Primary drug class: Antidepressants
Additional drug class(es): Serotonin-Selective Reuptake Inhibitors, Anxiolytics/Anti-anxiety

Approved & Off-Label Uses (Indications)

Lexapro’s US FDA Approved Treatment(s)

Major depressive disorder (MDD) in adults & adolescents. Generalized anxiety disorder (GAD) in adults.

Uses Approved Overseas but not in the US

  • Everywhere else in the world where you find Lexapro / Cipralex / etc. (escitalopram), it’s approved to treat Social Anxiety Disorder (SAnD) 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

Off-Label Uses of Lexapro

The entire panic-anxiety spectrum, including: Social anxiety disorder (SAnD), obsessive compulsive disorder (OCD), and post traumatic stress disorder (PTSD). Also bipolar depression.

When & If Lexapro Will Work

Lexapro’s Usual Onset of Action (when it starts working)

Lexapro can start working within one week. You should still give it at least three weeks. Unless the side effects hit hard and fast. Return to Table of Contents

Likelihood of Working

If you’ve never taken an antidepressant before, and for all you and your doctor know serotonin is a big part of your problem, the odds are pretty damn good that Lexapro will help for MDD. Although the odds of Lexapro working may not be statistically much better than Celexa (citalopram), they both have better chances of working for MDD than all the other SSRIs, and most other antidepressants. I.e. around a 60–75% chance of response (they’ll do something positive) and 50–70% chance of remission (kiss that MDD goodbye, as long as you’re taking your meds).

The odds are similar for GAD.

Return to Table of Contents

Taking and Discontinuing

How to Take Lexapro

Manufacturers’ Recommendations

Lundbeck & Forest’s Recommendations

Per the Lexapro Full US PI sheet: 10 mg once a day , for adults and adolescents with MDD , adults with GAD , and just about anything else. That’s it.

Crazymeds’ Suggestions

Start at 5mg a day for anything in the Anxiety or Depression spectra. Increase by 2.5 to 5mg a day after at least a week, and only if needed. Return to Table of Contents

How to Stop Taking Lexapro (discontinuation / withdrawal)

Decrease your dosage by 5mg every week. So if you’re taking 10mg a day, take 5mg for a week, then you can stop. 2.5mg a day if you really need to. If you experience severe SSRI discontinuation syndrome that’s not going away, talk to your doctor about a prescription for flouxetine or the oral solution for a slow tapering off. Return to Table of Contents

Lexapro’s Pros and Cons


Works faster than other serotonin-selective reuptake inhibitors (SSRIs). Many people who take it have reported 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. Return to Table of Contents


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. Return to Table of Contents

Interesting Stuff your Doctor Probably didn’t Tell You about Lexapro

If you want to be as much of a pedantic asshole about these things as I am, Lexapro is the only true SSRI. All the others affect something else, usually 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. Unfortunately its purity of serotonin action can lead to interference with dopamine and norepinephrine, and that can cause some problems. Return to Table of Contents

Best Known for

The Lexapro Yawn. It doesn’t matter that you’re not tired, you can 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.

Working faster than any SSRI or SNRI. Return to Table of Contents

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Lexapro’s Potential Side Effects

Potential Side Effects All Crazy Meds Have

No matter which neurological and/or psychiatric drug you take, you’ll probably get one or more of these side effects. These will usually be gone, or at least will diminish to the point where you barely notice it most of the time, 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.1
  • All crazy meds can, and probably will affect your dreams as well. There is no way of telling if that will be good or bad, let alone if this side effect is permanent or temporary.
  • Any of the above side effects you see listed again below means they’re even more likely to happen and/or stick around longer and/or are worse than most other meds.

Typical Potential Side Effects

The usual for SSRIs - headache, nausea, dry mouth, sweating, sleepiness or insomnia (with insomnia more likely), constipation weight gain and 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.” Return to Table of Contents

Uncommon Potential Side Effects

SSRI-Induced Indifference / Apathy. Teeth grinding (bruxism). Yawning, jaw tightening and clenching to the point of temporomandibular joint syndrome (TMJ) and a dental specialist’s intervention (e.g. wearing a mouth guard at night).

Return to Table of Contents

Freaky Rare Side Effects

Sexsomnia (I wish I could read Dutch), labial pigmentation and lichenoid eruption, and atypical jitteriness syndrome (which reads like a Prescott Pharmaceuticals product side effect).

Return to Table of Contents

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What You Really Need to be Careful About

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 (escitalopram) are on the list of drugs to totally avoid if you have a history of TdP/QTc/cardiac arrhythmia.

Return to Table of Contents

Pregnancy Category

C-Use with caution Return to Table of Contents


Lexapro’s Half-Life & How Long Until It Clears Your System

Half-life: 27–32 hours. Plasma Clearance: 6–8 days.

Steady State

Steady state reached in 6–8 days

Half-life is the average time it takes for you to process half of the drug’s active ingredient. If a drug has a half-life of around 24 hours and you take a dose of 100mg, you’ll have roughly the equivalent a 50mg dose after one day, a 25mg dose after two days, and so on. The rule of thumb is: multiply the half-life by five and you get how long it is for the dose you took to be cleared from your bloodstream2, so there’s nothing swimming around to attach itself to your brain and start doing stuff. That’s called “plasma clearance.” Complete clearance is a complex equation based on a lot of factors which may or may not: be published in the PI sheet, include personal data like your weight, or even completely figured out by corporate and independent researchers. It usually winds up being 2–5 days after plasma clearance no matter what3, but can take weeks. Sometimes a drug will clear from your brain and other organs before it clears from your blood.

Steady state is the flipside of half-life. This is when you can expect to get over side effects caused by fluctuating amounts of a medication in your bloodstream. Often, but not always the same amount of time as the plasma clearance above.

Return to Table of Contents

How escitalopram Works

the current best guess at any rate
Escitalopram does what all SSRIs are supposed to do increase the transmission and levels of serotonin, inhibit the serotonin reuptake pump, desensitize 5-HT1A receptors, and nothing else. As far as neurotransmitters are concerned. While the desensitization happens at 5HT1A, the reuptake inhibition happens at all 5-HT receptors. 5-HT1A may be all sweetness and light, but 5-HT2A inhibits dopamine, and when an SSRI causes you to have too much serotonin around your 5-HT2A receptors you get sexual (and other) side effects.

That’s why Lexapro won’t necessarily kill your libido, also why you won’t get a happy ending. And why all other side effects common to SSRIs don’t suck so hard with Lexapro.

Obviously this something where mileage is going to really vary. Return to Table of Contents

Active Ingredient

escitalopram oxalate

The active ingredient is usually the same as the generic name, but more often than not it’s a chemical salt of the substance identified as the generic. E.g. Fluoxetine is the generic for Prozac, but the active ingredient is fluoxetine hydrochloride (or HCl). It usually doesn’t make much of a difference outside of the more esoteric aspects of a drug’s pharmacology, but not always.

Return to Table of Contents

Shelf Life

Tablets - 3 years. Oral suspension - 2 years, 1 month after opening. Return to Table of Contents

Lexapro’s Noted Drug-Drug, Drug-Food & Drug-Supplement Interactions

Check for Other Drug-Drug, Drug-Food & Drug-Supplement Interactions Lexapro may have at

Drugs.com’s drug-drug and drug-food interaction checker

It’s always a good idea to check for drug-drug interactions yourself. Just because most people in the crazy meds business know about really important interactions (e.g. MAOIs and a lot of stuff, warfarin and everything on the planet) doesn’t mean the person who prescribed your meds told you about them, or the pharmacist has all the meds you take at their fingertips like they’re supposed to. Or they have the time to do their jobs properly when not dealing with complete idiots or playing Angry Farmers on teh Faecesbooks.
Learn more about drug-everything interactions on our page of tips about taking crazy meds.

Name, Address, Serial Number (Generic and Overseas Availability)

Available in the US as a generic? Yes

Other Trade Names and Overseas Availability

Not including controlled/extended/sustained release suffixes (Efexor ER, Trevilor retard e.g.) or branded generics that are a hyphenate of the generic name and the drug company name (Apo-Citalopram e.g.).

Available as Lexapro in These Countries

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

Available as Generic Escitalopram in These Countries

Australia, Argentina, Canada, Chile, the EU.

Transliterated, Overseas Trade and Branded Generic Names

  • Argentina: Esertia , Meridian
  • Australia: Esipram , Esitalo , Lexam , Loxalate
  • Spain: Esertia
  • essitalopraami is Finnish for escitalopram

Return to Table of Contents

Shapes & Sizes (How Supplied)

In the US: 5 mg tablets , 10 mg tablets , 20 mg tablets , oral solution

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. Return to Table of Contents

Comments, PI Sheet, Ratings, Reviews and More


Lexapro is probably the best-tolerated and most effective SSRI currently on the market. Mainly because it’s just a little better than Celexa (citalopram). Celexa was chosen as the first antidepressant used in the massive STAR*D study for being the best-tolerated SSRI and was considered the most effective. Lexapro was too new at the time. Is Celexa really more effective than all the other SSRIs? Yes, but not by all that much. It did rather well in the STAR*D study, with almost half the people responding, but a third of them relapsing. However, by sucking a lot less than the others, people keep taking Celexa and that makes it far more effective in the long run. The same is true for Lexapro. It sucks less, so people keep taking it.

Another thing Lexapro does well is preventing relapses.

Outside of the US Lexapro, as Cipralex and other brand names, is approved for a lot of conditions in the panic-anxiety spectrum. The data in some of the clinical trials I could find seem a bit dodgy, but there is no doubt that Lexapro works for most anxiety conditions. This raises a bit of a conundrum. I’d like to see a streamlining of the approval process for meds with overseas approvals. If a drug is already approved in the US, as Lexapro is, and is approved to treat other conditions in places like the UK, the EU, Canada, Australia, and Japan4, it should be really easy to get the med approved by the FDA to treat those conditions. The EU has higher standards than the US to get a med approved - the main one being not using a placebo to compare a new med with, but an existing med used to treat whatever the new med treats. But if the overseas approval is a little hinky, then it’s not much different from what happens here sometimes. Then again, if the med works and it’s not killing anyone, it’s a good thing, right? It’s like what you see on cop shows all the time. With nothing more than a hunch and tip from an unreliable source, some cops break down some doors and destroy a meth lab. Nobody wants meth labs in their neighborhood, but they don’t want the cops breaking down doors whenever they feel like it.

Return to Table of Contents

Rate Lexapro

Give your overall impression of Lexapro on a scale of 0 to 5.

Get all critical about Lexapro

4 stars Rating 3.6 out of 5 from 436 criticisms.
Vote Distribution: 53 – 14 – 21 – 36 – 165 – 147

Rate this article

If you’re still feeling judgmental as well as just mental5, please boost or destroy my self-confidence by honestly (and anonymously) rating this article on a scale of 0 to 5. The more value-judgments the better, even if you can criticize my work only once.

Get all judgmental about the Lexapro (escitalopram) Synopsis

4.5 stars Rates 4.2 out of 5 from 252 value judgments.
Vote Distribution: 11 – 3 – 5 – 14 – 94 – 125

Return to Table of Contents

Pages and Forum Topics Google Thinks are Relevant to Your Mental Health

Full US PI sheet, Global SPCs & PILs, Other Consumer Review & Rating Sites, and Other Sites that may be of Interest

Lexapro’s Full US Prescribing Information / PI Sheet

Official Sites

PI Sheets from Around the World

Rating & Review Sites

Other Sites of Interest

DrugsDB.com Lexapro page Return to Table of Contents

Discussion board

If you have any questions not answered here, please see the Crazymeds Lexapro discussion board. Return to Table of Contents

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  1. Lexapro’s Full US Prescribing Information
  2. Faught, Edward. “Topiramate in the treatment of partial and generalized epilepsy.” Neuropsychiatric disease and treatment 3.6 (2007): 811-821.
  3. Stahl’s Essential Psychopharmacology: Neuroscientific Basis and Practical Applications (Essential Psychopharmacology Series) Third edition ISBN:978-0521673761 by Stephen M. Stahl © 2008 Published by Cambridge University Press.
  4. Primer of Drug Action 12th edition by Robert M. Julien Ph.D, Claire D. Advokat, Joseph Comaty © 2011 ISBN:978-1429233439 Published by Worth Publishers.
  5. The Prescriber’s Guide (Essential Psychopharmacology Series) Third edition by Stephen Stahl © 2009 Published by Cambridge University Press.
  6. Clinical Handbook of Psychotropic Drugs 18th edition Adil S. Virani, K. Bezchlibnyk-Butler, J. Jeffries © 2009 Published by Hogrefe & Huber Publishers.
  7. Mosby’s Drug Consult 2007 (Generic Prescription Physician’s Reference Book Series) © 2007 An imprint of Elsevier.
  8. PDR: Physicians’ Desk Reference 2010 64th edition
  9. The therapeutic potential of escitalopram in the treatment of panic disorder

Return to Table of Contents

1 As well as being an indication of half of said conditions.

2 Based on Julien's calculations from A Primer of Drug Action, the half-life multiplied by five is the generally accepted estimate of how long it takes a single dose of any given drug to be eliminated from the blood stream/plasma of someone with a normal metabolism. That's also the rough estimate for steady state if they can't get, or won't provide a number for that.

3 For crazy meds. I have no idea what the average complete clearance is for other types of medications. For all I know there are drugs that utterly vanish from your system in under five passes, and others that won't let go of your squishy bits for years after you stop taking them.

4 Or, as far too many Americans classify it: where the white people live; we'll just count the Japanese as honorary white people.

5 Thank you! I'll be here all weak. Be sure to tip your content provider. And don't try the veal, it's cruelicious!

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 (crazymeds.us)

Last modified on Wednesday, 04 May, 2016 at 16:45:52 by JerodPoorePage Author Date created Sunday, 05 December 2010 at 13:49
“Lexapro (escitalopram): a Review for the Educated Consumer.” by Jerod Poore is copyright © 2010 Jerod Poore Published online 2010/12/05
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Lexapro, and all other drug names on this page and used throughout the site, are a trademark of someone else. Lexapro’s PI Sheet 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 © 2003 - 2016. All rights reserved.
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Almost all of the material on this site is by Jerod Poore and is copyright © 2003, 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, and 2016 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 from the medications’ product information / summary of product characteristic (PI/SPC) sheets and/or medication guides - which is all you get from sites like WebMD, RxList, NAMBLA NAMI, etc., the sources that are referenced throughout the site, our personal experience and the experiences family, friends, and what people have reported on various reputable sites all over teh intergoogles. 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 medication guide/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 ridiculously large screens and browsers that don’t block ads. I use Firefox and Chrome, running under 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.
Crazymeds now uses a secure server, but it is not so secure that you can discuss anything having to do with nuclear power facilities, air traffic control systems, aircraft navigation systems, weapons control systems, or any other system requiring failsafe operation whose failure could lead to injury, death or environmental damage. Just so you know. So if you’re mentally interesting and have a job that deals with that sort of thing, talk about said job elsewhere. Otherwise feel free to discuss your meds and brain cooties.
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 as anonymity on teh Intergoogles. 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.

* Yes, I know I’m using open source browsers. I also test the site using the now-defunct IE and Safari browsers. Their popularity - and superiority - killed IE and Safari, so that’s why I rely on the open source browsers. It’s like brand vs. generic meds. Sometimes the generic is better than the brand.

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