Mirror Health
Medication Guide
Escitalopram (Lexapro)
SSRI · Selective Serotonin Reuptake InhibitorA once-daily medication used to support mood and anxiety. Here's what to expect while taking it.
FDA-approved for: major depressive disorder and generalized anxiety disorder
What patients often ask
Some feel sleepy early on, others more alert. Drowsy? Take it at night. Keeps you up? Take it in the morning.
Usually small if it happens. Worth tracking if it matters to you.
Alcohol isn't recommended with escitalopram — it can deepen low mood and add to drowsiness.
Not addictive, no "high." But don't stop abruptly — tapering off gradually avoids discontinuation symptoms.
Many take it for months to a year or more after feeling well, then taper off. A shared decision, not a life sentence.
These likelihood ratings draw on prescribing references and clinical experience — a general guide, not a precise prediction for any individual.
Why I prescribe Escitalopram
Escitalopram is often the first medication I prescribe for patients with depression and anxiety. The starting dose (10 mg) can be effective without needing an increase; most patients experience it as energy- and weight-neutral, and stopping the medication is generally well tolerated.
How it's taken
Most adults start at 10 mg once daily, some at 5 mg. A prescriber may raise it to a maximum of 20 mg after at least a week. Tablets come in 5, 10, and 20 mg.
Take it once a day, same time, with or without food. It's a daily medicine — not something to take only when symptoms flare.
Older adults and people with significant liver problems usually stay at 10 mg max.
How long until it works
Sleep, appetite, and energy often improve in the first 1–2 weeks. Full benefit for mood and anxiety usually takes 4–6 weeks, sometimes up to 8.
Not feeling different at first is normal. Keep taking it and check in rather than stopping on your own.
If you miss a dose
Take it when you remember that day. If your next dose is close, skip it — don't double up.
Common side effects
Most ease over the first couple of weeks:
- Nausea, dry mouth, or sweating
- Trouble sleeping, or feeling sleepy
- Headache or dizziness
- Constipation, diarrhea, or lower appetite
- Sexual side effects — lower interest, delayed orgasm, or ejaculation difficulty
If any stick around, there are often ways to help.
Serious side effects
Uncommon, but contact your prescriber promptly — or get urgent care if severe:
- Serotonin syndrome — agitation, fast heartbeat, sweating, shivering, muscle twitching or stiffness, confusion
- New or worsening agitation, or thoughts of self-harm (see boxed warning)
- Unusual bleeding or bruising — higher risk with aspirin, NSAIDs, or blood thinners
- Low sodium — headache, weakness, confusion, or unsteadiness, especially in older adults
- Signs of mania — racing thoughts, little need for sleep, unusually high energy
- Eye pain or sudden vision changes
- A seizure (rare)
- Allergic reaction — rash, swelling, trouble breathing → call 911
Suicidal thoughts in young people
Antidepressants can raise the risk of suicidal thoughts in people under 25, most often in the first weeks or after a dose change.
Watch for worsening mood, agitation, or thoughts of self-harm during that window, and stay in touch with your prescriber. It's a reason to monitor closely, not a sign the medicine is unsafe for everyone.
Stopping the medication
Don't stop abruptly — it can cause dizziness, flu-like feelings, irritability, or brief "brain-zaps." When it's time, your prescriber will lower the dose gradually.
Interactions & cautions
- MAOIs: don't combine, or use within 14 days of stopping one.
- Tell your prescriber about all medicines and supplements — especially other serotonin-affecting ones (antidepressants, triptans, tramadol, St. John's Wort), blood thinners or NSAIDs, and pimozide.
- Alcohol isn't recommended.
- Mention pregnancy, planning, or breastfeeding so you can weigh options together.