What Is Escitalopram (Lexapro)?

The drug Escitalopram is a selective serotonin reuptake inhibitor (SSRI), commonly found under the brand name, Lexapro. This medication is typically prescribed to treat depression or generalized anxiety disorder (GAD); however, it may be prescribed off label to treat other conditions or to treat mental health problems associated with addiction.

How Do SSRIs like Escitalopram Work?

SSRIs in general increase the amount of serotonin in the brain.  This neurotransmitter is associated with mood, so when there is not enough of it in the brain, the person can feel depressed or anxious. Medications in the SSRI family prevent serotonin from being reabsorbed quickly, so the neurotransmitter can help neurons communicate. When neurons fire more often, the person feels better; their mood is elevated, and they have more physical energy. Long-term, the balance of serotonin and the ability of neurons to communicate better help to stabilize the person’s mood.

Escitalopram Dosage Overview

Escitalopram comes in 5 mg, 10 mg, or 20 mg tablets as well as a liquid suspension. These are taken orally, once per day. The average starting dose depends on the condition that escitalopram is prescribed to treat, but ranges from 10 mg to 20 mg per day. This dose can be adjusted as needed by the overseeing physician.

SSRIs in general take weeks to fully effect mood; escitalopram requires between one and four weeks of regular doses to be fully effective. It is important for people struggling with depression or anxiety to be patient and wait for the medication to work. However, if there are no noticeable mental changes in over a month, the individual and their doctor should discuss another treatment.

What Escitalopram Should Do

Escitalopram should adjust the brain’s levels of serotonin to improve and stabilize mood. This helps relieve symptoms of depression and anxiety. When used as prescribed, along with therapy, escitalopram is a great tool to combat mood disorders.

Side Effects of Escitalopram

Most people do not experience serious side effects when taking escitalopram. Any side effects typically go away after a few weeks, once the body has grown accustomed to the medication. However, there are some side effects that may include:

• Nausea or vomiting
• Diarrhea
• Constipation
• Indigestion
• Other abdominal or digestive issues
• Changes in sex drive
• Irritability or mood swings
• Rebound depression or anxiety
• Increased sweating
• Dizziness
• Fatigue or exhaustion
• Increased appetite and weight gain
• Dry mouth
• Runny nose, sneezing, or other flu-like symptoms

There are some serious side effects that could indicate a bad reaction to escitalopram. These include:

• Unusual excitement
• Mania
• Hallucinations
• Delusions
• Irregular heartbeat or racing heart
• Serious muscle stiffness
• Fever
• Extreme confusion

It is important to contact 911 immediately when experiencing these symptoms.
Additionally, people who are younger than 24 years old are at an increased risk of developing suicidal thoughts or actions when taking SSRIs, including escitalopram.

People who have bipolar disorder that has not been diagnosed, or which has been misdiagnosed as depression, are more likely to experience a serious manic episode. When a person experiences mania or hypomania, they should not take escitalopram.

Long-Term Use

Escitalopram has no long-term side effects except for potential dependence and tolerance, which are not associated with addiction in this instance. A doctor will work with their patient to appropriately adjust their dose of escitalopram to help with dependence and tolerance over time and, at some point, may decide to switch their patient to a different antidepressant. If a person has an undiagnosed pre-existing condition, like liver disease, seizure disorder, kidney problems, or a thyroid problem, escitalopram may make these conditions worse.

Taking an SSRI like escitalopram has been associated with weight gain, which may be difficult to lose or moderate while on the antidepressant. People who have weight-related conditions already should consult their doctor before taking an antidepressant in order to avoid additional unhealthy weight gain.

Is Escitalopram Addictive?

This medication is not considered addictive, although some people develop a tolerance to it, and dependence on it, which can lead to withdrawal symptoms. The definition of addiction is the compulsion to ingest intoxicating substances, and since escitalopram does not act quickly enough on brain chemistry to induce a high, it is an unlikely target of abuse or addiction. People who have struggled with substance abuse or polydrug abuse in the past may attempt to abuse escitalopram. The medication also has interactions with several drugs, including other prescription medications, so some people may attempt to combine escitalopram to enhance a high from another drug. This is very rare, however.

Overdosing on Escitalopram

It is possible to overdose on escitalopram, either by taking too much of the medication or by mixing different types of antidepressants, including other SSRIs, tricyclic antidepressants, or MAO inhibitors. This leads to serotonin syndrome, in which the brain is flooded with too much serotonin. Symptoms of this overdose include:

• Extreme agitation or restlessness
• Extreme confusion
• Rapid or irregular heartbeat
• High blood pressure
• Dilated pupils
• Loss of physical coordination
• Muscle twitches or spasms
• Muscle rigidity
• Heavy sweating
• Intestinal issues
• Headache
• Shivering
• Goosebumps

Mild cases of serotonin syndrome may clear up on their own; however, severe serotonin syndrome is a medical emergency. This syndrome includes symptoms:

• High fever
• Falling unconscious
• Seizures
• Irregular heartbeat

Substitutions for Escitalopram

Right now, SSRIs are considered to be the best medications in the treatment of depression and GAD. There are other possible treatments, but they are not typically designed to work long-term, or they are more likely to have negative side effects that reduce a person’s ability to enjoy life.

People who have surges of anxiety that lead to panic attacks may benefit from “as needed” treatment with benzodiazepines like Klonopin or Xanax. These medications work much faster on the brain than SSRIs, inducing an immediate sense of relaxation and potentially euphoria, which could lead to addiction. However, they do work quickly, which helps to ease panic attacks. Buspirone is a benzodiazepine that works much more slowly – in fact, it takes a few weeks to completely work, more like an antidepressant – and this may be a more effective longer-term treatment for some people struggling with GAD.

In some instances of anxiety disorder, other tranquilizers or sedatives may be appropriate; however, these medications can affect a person’s ability to perform tasks like driving, and they can be habit-forming. As a result, it is important to work closely with a doctor to ensure safe use of these medications.

If SSRIs are not effective in the treatment of depression, a person’s physician may switch them to another type of antidepressant, such as a serotonin norepinephrine reuptake inhibitor (SNRI), tricyclic antidepressant, or MAO inhibitor. These are more potent, however, and can lead to more side effects. MAO inhibitors in particular require supervision and care, including dietary restrictions, since they interact with many chemicals.

Some people can manage depression or anxiety with a combination of therapy, exercise, and dietary changes. While healthier foods and exercise can help to regulate mood, these changes alone will not work for everyone.

It is important to remember that medications like escitalopram are designed to be part of a treatment plan that includes therapy. By themselves, prescription medications will not treat mood disorders or other mental health issues. A person must work with a therapist to understand the patterns of their condition, develop skills to cope with symptoms, and find long-term, healthy ways to keep themselves stable and happy.

Escitalopram Use in Addiction Treatment

Scientific research is uncovering the link between mental health and substance abuse. People who struggle with mood disorders like depression and anxiety are more susceptible to developing an addiction to drugs or alcohol, often to self-medicate symptoms of their underlying mental health condition. These co-occurring disorders can make each other worse without proper treatment.

Many rehabilitation programs keep up with scientific understanding of co-occurring disorders and offer treatment for mood disorders alongside therapy for addiction. Escitalopram may be part of addiction treatment to help a mood disorder. A person who receives a prescription for escitalopram while participating in a rehabilitation program may use this medication for a long time, if it is effective; however, medical supervision is required.