Lexapro: Effective SSRI Treatment for Depression and Anxiety
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Synonyms | |||
Lexapro (escitalopram oxalate) is a selective serotonin reuptake inhibitor (SSRI) approved by the FDA for the treatment of major depressive disorder (MDD) and generalized anxiety disorder (GAD) in adults and adolescents. As one of the most widely prescribed antidepressants globally, Lexapro offers a favorable balance of efficacy and tolerability, making it a first-line option for clinicians managing mood and anxiety disorders. Its mechanism of action involves enhancing serotonin activity in the central nervous system, which is critical for regulating mood, emotion, and anxiety.
Features
- Active ingredient: Escitalopram oxalate
- Available in 5 mg, 10 mg, and 20 mg film-coated tablets
- Also available as a liquid oral solution (1 mg/mL)
- Selective serotonin reuptake inhibitor (SSRI) class
- FDA-approved for major depressive disorder and generalized anxiety disorder
- Bioavailability approximately 80%
- Peak plasma concentration reached within 5 hours post-dose
- Half-life of 27–32 hours, allowing for once-daily dosing
- Hepatic metabolism via CYP2C19, CYP3A4, and CYP2D6 isoenzymes
Benefits
- Effectively reduces symptoms of depression, including low mood, loss of interest, and fatigue
- Alleviates excessive worry, tension, and physical symptoms associated with generalized anxiety disorder
- Generally well-tolerated with a lower incidence of side effects compared to some older antidepressants
- Once-daily dosing supports treatment adherence and convenience
- Non-sedating profile allows for daytime use without significant drowsiness for most patients
- Demonstrated efficacy in both short-term and maintenance therapy for relapse prevention
Common use
Lexapro is primarily indicated for the treatment of major depressive disorder (MDD) in adults and adolescents aged 12–17 years, as well as generalized anxiety disorder (GAD) in adults. It is often prescribed as a first-line pharmacological intervention due to its established efficacy and generally favorable side effect profile. Clinicians may also use Lexapro off-label for other anxiety-related conditions, such as panic disorder, social anxiety disorder, and obsessive-compulsive disorder, though supporting evidence varies. Treatment is typically initiated at a low dose and titrated based on therapeutic response and tolerability.
Dosage and direction
For major depressive disorder and generalized anxiety disorder in adults, the recommended starting dose is 10 mg once daily, which may be increased to 20 mg after a minimum of one week based on individual response. For adolescents aged 12–17 with MDD, the starting dose is 10 mg once daily, with a recommended dose range of 10–20 mg daily. Lexapro should be taken with or without food, preferably at the same time each day to maintain consistent plasma levels. Dose adjustments are necessary in patients with hepatic impairment, with a maximum recommended dose of 10 mg daily. Treatment should be continued for at least 6–12 months after symptom remission to reduce the risk of relapse.
Precautions
Patients should be monitored closely for clinical worsening, suicidality, or unusual changes in behavior, particularly during the initial few months of therapy or following dose changes. Lexapro may increase the risk of bleeding, especially when used concomitantly with NSAIDs, aspirin, or other anticoagulants. Use with caution in patients with a history of seizures or conditions that predispose to seizures. Discontinuation symptoms may occur upon abrupt cessation; gradual tapering is recommended. Lexapro may cause hyponatremia, particularly in elderly patients or those taking diuretics. Patients should be advised regarding the potential for impaired judgment, thinking, or motor skills—activities such as driving or operating machinery should be undertaken with caution until the individual’s response to the drug is known.
Contraindications
Lexapro is contraindicated in patients taking monoamine oxidase inhibitors (MAOIs) or within 14 days of discontinuing MAOI treatment due to the risk of serotonin syndrome. Concomitant use with pimozide is contraindicated due to the potential for QT prolongation. It is also contraindicated in patients with known hypersensitivity to escitalopram, citalopram, or any component of the formulation. Use is not recommended in patients with severe renal impairment or untreated narrow-angle glaucoma.
Possible side effect
Common side effects (≥5% and greater than placebo) include nausea, insomnia, ejaculation disorder, fatigue, drowsiness, increased sweating, and decreased libido. Less frequently reported adverse reactions include dry mouth, constipation, dizziness, increased appetite, and anxiety. Serious side effects may include serotonin syndrome, abnormal bleeding, angle-closure glaucoma, hyponatremia, manic episodes, and seizures. Sexual side effects such as anorgasmia, erectile dysfunction, and diminished interest in sex may occur and persist in some patients even after discontinuation.
Drug interaction
Lexapro has a moderate potential for drug interactions primarily mediated through CYP450 isoenzymes. Concomitant use with MAOIs is contraindicated. Strong inhibitors of CYP2C19 (e.g., fluconazole, omeprazole) may increase escitalopram levels. Use with serotonergic drugs (e.g., tramadol, triptans, other SSRIs) increases the risk of serotonin syndrome. Lexapro may enhance the anticoagulant effect of warfarin and increase bleeding risk. Concomitant use with drugs that prolong the QT interval (e.g., antipsychotics, antiarrhythmics) should be approached cautiously. Lexapro may decrease the efficacy of tamoxifen through CYP2D6 inhibition.
Missed dose
If a dose is missed, it should be taken as soon as remembered unless it is close to the time of the next scheduled dose. In that case, the missed dose should be skipped, and the regular dosing schedule resumed. Doubling the dose to make up for a missed dose is not recommended.
Overdose
Symptoms of Lexapro overdose may include dizziness, sweating, nausea, vomiting, tremor, drowsiness, and sinus tachycardia. In severe cases, serotonin syndrome, seizures, coma, or ECG changes (including QT prolongation) may occur. There is no specific antidote; treatment is supportive and symptomatic. Gastric lavage may be considered if presented early. Activated charcoal may be administered. ECG monitoring is recommended for at least 24 hours in cases of significant ingestion.
Storage
Store Lexapro tablets and oral solution at room temperature (20–25°C or 68–77°F), with excursions permitted between 15–30°C (59–86°F). Keep the bottle tightly closed and protect from light and moisture. Keep out of reach of children and pets. Do not use beyond the expiration date printed on the packaging.
Disclaimer
This information is intended for educational purposes only and does not constitute medical advice. Lexapro is a prescription medication and should only be used under the supervision of a qualified healthcare professional. Individual response to treatment may vary. Patients should discuss benefits, risks, and alternative treatments with their prescribing physician. Never initiate, adjust, or discontinue medication without consulting a healthcare provider.
Reviews
Clinical studies and post-marketing surveillance indicate that Lexapro is generally effective and well-tolerated. Many patients report significant improvement in mood and anxiety symptoms within 4–6 weeks of treatment initiation. Common positive feedback includes reduced anxiety, improved sleep, and enhanced overall functioning. Criticisms often relate to side effects such as sexual dysfunction, weight gain, or initial activation symptoms like jitteriness. Long-term users frequently appreciate the once-daily dosing and stability provided by maintenance therapy. As with all antidepressants, individual experiences vary widely, and a period of dose adjustment may be necessary to optimize outcomes.