How long does it take for lexapro to work for panic attacks?

How Long Does Lexapro Take To Work?

Lexapro (generic escitalopram) is an oral medication used for the treatment of the major depressive disorder and generalized anxiety disorder in adults and adolescents. The escitalopram drug class is selective serotonin reuptake inhibitors (SSRIs). As the name suggests, these medications prevent the reuptake of a neurotransmitter called serotonin at the junctions between nerve cells in the brain. Low levels of serotonin are associated with depression.
What does Lexapro do? By inhibiting reuptake of the neurotransmitter, the drug allows increased levels of serotonin to remain at the synapse (nerve junction), thereby improving mood, behavior, sleep, appetite, and other symptoms of anxiety and depression. How does escitalopram work? What are the side effects of Lexapro? How long does escitalopram take to work? What are the risks of using this medication long-term? Read on to find out the answers to these questions and more.

Hope Without Commitment

Find the best treatment options.
Call our free and confidential helpline

Most private insurances accepted

Marketing fee may apply

Table of Contents

  • What Is Escitalopram Mechanism Of Action?
  • How Quickly Does Lexapro Work?
  • Shall One Stop Escitalopram With Symptom Improvement?
  • What Are The Risks Of Long-Term Lexapro Use?
  • What To Discuss With The Doctor Before Taking Escitalopram?

How Does Lexapro Work?

Lexapro (generic form Escitalopram oxalate) is available as a tablet or solution. Lexapro ingredients include certain inactive substances such as glycerin in addition to the active drug. Lexapro cost is relatively inexpensive, and the generic formulation is covered by most insurance plans. At the recommended dose of Lexapro 10 mg, this medication is highly effective in treating acute episodes of depression, including symptoms such as feelings of sadness, hopelessness, and guilt, loss of interest in previously enjoyed activities, sleep disturbances, suppressed appetite, and low energy. What is Lexapro prescribed for? It is given for anxiety symptoms such as irritability, restlessness, tiredness, and difficulty concentrating.

What does Escitalopram do to improve these symptoms?

SSRIs (selective serotonin reuptake inhibitors) block the reuptake of serotonin, a neurotransmitter in the human brain. This keeps serotonin in the gap between neurons instead of it being carried back into the cell. Escitalopram is a very potent SSRI, up to 40 times more powerful than R-citalopram, the other enantiomer of the drug. It is highly selective in blocking the reuptake of serotonin without affecting other neurotransmitters such as norepinephrine or dopamine. Serotonin (5-HT) is a chemical responsible for regulating some body functions, including mood, emotions, behavior, sleep, appetite, and sexual desire.

How does Lexapro work in the brain?

By blocking the transporter molecule that carries serotonin back into the neuron (nerve cell, it makes more serotonin remain in the synapse (junction between nerve cells). This amplifies the effect of serotonin and thereby reduces the signs and symptoms of anxiety and depression.

Does Escitalopram Affect Weight?

Can Lexapro cause weight loss? The medication can indirectly affect a person’s weight. There are some reports that it reduces the severity of binge eating as well as body mass index in overweight individuals. Also, by treating the underlying depression, the drug can reverse appetite changes and potentially cause a weight gain or loss.

How Quickly Lexapro Works

Depression and anxiety can be crippling, affecting an individual’s ability to function normally in society. Therefore, it is not unusual for individuals struggling with depression to ask does Lexapro work right away? The answer is yes and no. For symptoms related to sleep, appetite, and energy, Lexapro works fast, and some improvement may be evident within 1-2 weeks of beginning treatment. Relief of physical symptoms is a good indicator that the medication is effective and doing its job. However, it is practically unheard of that Lexapro worked immediately for relieving symptoms such as depressed mood or lost interest in activities, and these symptoms typically take 6-8 weeks to improve.
How long until Lexapro works can be explained by the class of drugs this medication belongs to. SSRIs, in general, take four to six weeks to kick in because of the time taken to suppress previously active serotonin transporter molecules. How long does it take for Lexapro to start working? Some people may not notice a difference for as long as two months. This delayed response is thought to be due to an impairment in the G protein signaling system which prevents the antidepressant from functioning properly when it is initially taken.

Stopping Treatment After Escitalopram Immediate Effects

There are usually very few Lexapro immediate effects, but the medication does eventually kick in with improvement in symptoms of depression and anxiety. People who have been prescribed this medicine may be tempted to stop treatment once they start to feel better. However, one should not stop taking escitalopram without talking to a doctor first. Only a physician can determine the appropriate length of treatment.
Some people may need to discontinue treatment due to side effects such as Lexapro dreams. However, stopping the medication abruptly can result in withdrawal symptoms such as headaches, nightmares, dizziness, nausea, vomiting, and tingling/prickling sensations. Skipped doses can result in a relapse of symptoms. If Lexapro stopped working or the side effects are intolerable, physicians usually advise a gradual reduction in dose instead of abrupt cessation of treatment. Careful monitoring of symptoms is advisable while treatment is slowly discontinued.

Is It Safe to Take Lexapro Long-Term?

There are no reported problems with long-term use of escitalopram as long as it is taken according to the directions given by a physician. If the medication is used for an extended length of time, periodic reevaluation is recommended to confirm does Lexapro work and should maintenance treatment be continued.
How does Lexapro work for anxiety? As noted, there can be a substantial delay before SSRI antidepressants improve symptoms. There are reports of worsening symptoms and/or increased suicidal ideation and behavior in vulnerable individuals, such as children, adolescents, and young adults, and these patients warrant cautious management during anxiety treatment.
Also, certain drug interactions can cause problems. For example, using Lexapro and ibuprofen together can increase the risk of bleeding, especially in people with liver or kidney disease. Careful monitoring is needed when the medication is prescribed to high-risk populations, such as residents of a recovery center for drug abusers. Not only is there a delay in how long does it take for escitalopram to work, but the drug may stop working due to worsening depression or other medical conditions and treatments, which is why it’s important to talk to a physician about concerns and questions.

Questions to Ask the Doctor about Escitalopram Treatment

Here are some things to discuss with the doctor before starting SSRI treatment:

  • Most prominent and bothersome symptoms
  • Any suicidal thoughts
  • Mental health diagnoses, especially bipolar disorder
  • Past treatment for depression or history of Lexapro not working
  • Current medications, including over-the-counter supplements
  • Pregnancy status

Possible questions to ask a physician before beginning antidepressant therapy:

  1. How fast does Lexapro work for anxiety and depression? When should I expect my symptoms to improve?
  2. How to take the medication? With food or without? At what time of day?
  3. What are the possible side effects?
  4. What to do in case of a missed dose?
  5. Is it safe to combine escitalopram and alcohol?
  6. What other medications can it interact with?
  7. Can Lexapro stop working?
  8. Is this a suitable treatment for those abusing drugs?
  9. Lexapro how long can it be taken safely?

Although Escitalopram onset of action can be delayed, it is an effective treatment for depression and anxiety in many individuals. However, like all medications, it is associated with the risks of side effects, drug interactions, and lack of effectiveness. The important thing is not only how fast does Lexapro work, but discussing every aspect of SSRI treatment with a physician before starting on an antidepressant.

Find the best treatment options.
Call our free and confidential helpline

Most private insurances accepted

Marketing fee may apply

View Sources

How long does it take for Zoloft to work?

Zoloft isn’t only for major depression. It’s also used to treat obsessive-compulsive disorder, panic disorder, post-traumatic stress disorder, premenstrual dysphoric disorder (PMDD) and social anxiety disorder.

Zoloft, an oral antidepressant pill made of compressed crystalline powder, is usually prescribed to first-time users in a 50-milligram-per-day dose for depression and PMDD and 25 milligrams per day for other disorders. Dosages can be increased with time and medical supervision up to 200 milligrams per day. It’s also available in liquid form .

Advertisement

Within just a few hours of taking an SSRI for the first time, the levels of serotonin in the brain and bloodstream increase. Yet, we don’t feel immediate results. Zoloft takes weeks to work. Why?

The answer is us. Our bodies need time to adapt to the new normal created by taking a pill laced with sertraline that is designed to increase serotonin levels in the brain. Not only does this SSRI medication help the brain absorb serotonin into the blood stream more effectively, but it may actually change the makeup of the brain. The brain needs new receptors to help absorb the additional serotonin; it builds and installs additional receptors — a biological process that can take up to eight weeks. So, even though Zoloft increases the levels of serotonin in our bodies nearly immediately, our brains aren’t immediately equipped to absorb it .

If, however, after six to eight weeks, Zoloft doesn’t seem to be positively affecting your mood, anxiety — or other condition for which it was prescribed — it’s time to alert your physician. Not every antidepressant will work the same for every person, and an estimated 50 percent of people who try an antidepressant will need to take a different brand or class before finding one that works for them. Or, it could just be that your dosage needs to be increased .

Your physician will help determine your type and dosage of antidepressant by considering your symptoms, other medications you are taking, health conditions, potential side effects, and whether you are pregnant or breastfeeding. In addition, she may inquire as to whether a particular antidepressant has been taken by a close relative, and what the results were. If your brother’s depression, for example, lifted after taking Zoloft, yours probably will, too .

Author’s Note: How long does it take for Zoloft to work?

Zoloft and other antidepressants take a few weeks to work. This is information I’ve heard before. What I’d never heard, however, was “why.” The idea that Zoloft increases the levels of serotonin — a mood-boosting chemical in the brain — almost immediately after taking the first few doses was a new one to me. But what really astounded me was the idea that in response, the brain is physically changing. Growing new receptors. Absorbing serotonin in greater amounts. And, in turn, affecting mood and behavior. The human body is amazing.

About escitalopram

Type of medicine A selective serotonin reuptake inhibitor (SSRI) antidepressant
Used for Depression, and anxiety disorders (such as panic disorder, social anxiety disorder, generalised anxiety disorder and obsessive-compulsive disorder) in adults
Also called Cipralex®
Available as Tablets and oral liquid drops

Escitalopram belongs to a group of medicines called SSRI antidepressants. It is prescribed for the treatment of some mood and anxiety disorders. These are depression, panic disorder, social anxiety disorder, generalised anxiety disorder and obsessive-compulsive disorder.

Both depression and anxiety disorders can develop for no apparent reason, but they can also be triggered by a life event such as a relationship problem, a work-related problem, bereavement, or illness. Whatever the cause of the problem, when the symptoms are severe enough, they can interfere with normal day-to-day activities. When this happens, taking a medicine such as escitalopram can help to ease the symptoms and restore normal daily routines. Escitalopram works by regulating the level of a certain chemical in your brain, called serotonin.

Before taking escitalopram

Some medicines are not suitable for people with certain conditions, and sometimes a medicine can only be used if extra care is taken. For these reasons, before you start taking escitalopram it is important that your doctor knows:

  • If you are pregnant, trying for a baby or breastfeeding.
  • If you have any problems with the way your liver works, or any problems with the way your kidneys work.
  • If you have a heart condition or heart rhythm disorder.
  • If you have epilepsy.
  • If you have sugar diabetes.
  • If you have increased eye pressure (called glaucoma).
  • If you have ever had a bleeding disorder, or a stomach or duodenal ulcer.
  • If you have ever had abnormally ‘high’ moods, called mania.
  • If you are being treated with electroconvulsive therapy (ECT).
  • If you have ever had an allergic reaction to a medicine.
  • If you are taking any other medicines. This includes any medicines you are taking which are available to buy without a prescription, as well as herbal and complementary medicines.

How to take escitalopram

  • Before you start the treatment, read the manufacturer’s printed information leaflet from inside the pack. It will give you more information about escitalopram and will provide you with a full list of the side-effects which you may experience from taking it.
  • Take escitalopram exactly as your doctor tells you to. It is prescribed as a once-daily dose. You can generally take it at a time to suit you, but try to take your doses at the same time of day, each day. You can take escitalopram either with or without food.
  • There are several strengths of tablet available; 5 mg, 10 mg and 20 mg. Your doctor will tell you which strength is right for you. This information will also be on the label of the pack you have been supplied with.
  • If you have been given escitalopram oral drops, your doctor will tell you how many drops to take each day:
    • Turn the bottle completely upside down. If no drops come out, tap the bottle lightly to start the flow.
    • Count the correct number of drops into a drink of water, orange juice or apple juice. Stir the liquid briefly, and then drink it straightaway.
  • If you forget to take a dose, take it as soon as you remember. If you do not remember until the following day, leave out the forgotten dose from the previous day and take the dose that is due as normal. Do not take two doses at the same time to make up for a missed dose.

Getting the most from your treatment

  • Try to keep your regular appointments with your doctor. This is so your doctor can check on your progress.
  • You may feel that escitalopram is not helping you straightaway. This is because it can take a week or two before the effect begins to build up, and a few weeks more before you feel the full benefit. It is important that you continue to take escitalopram, even if it takes a little while for your condition to improve.
  • If you develop any depressing or suicidal thoughts or ideas, you should let your doctor know about it as soon as possible. These thoughts can be associated with your condition and also with your treatment (particularly when the treatment is first started). It is very important that you tell your doctor about any distressing thoughts or ideas.
  • There are several types of antidepressants and they differ in their possible side-effects. If you find that escitalopram does not suit you then let your doctor know, as another may be found that will.
  • If you drink alcohol, ask your doctor for advice about drinking while you are on escitalopram. Drinking alcohol could increase the risk of unwanted effects such as feeling sleepy.
  • If you buy any medicines, check with a pharmacist that they are suitable to take with escitalopram. This is because several medicines which are available from general retail outlets can increase the risk of unwanted effects. In particular, do not take the herbal remedy called St John’s wort, and please ask for advice before buying any anti-inflammatory painkillers such as ibuprofen or aspirin.
  • Keep taking escitalopram until your doctor tells you otherwise. Your treatment is likely to last for several months – this is normal and helps to prevent your symptoms from recurring. Stopping suddenly can cause symptoms such as headache, sickness, anxiety, dizziness, shakiness and sleeping problems, so when it is time for your treatment to finish, your doctor will reduce your dose gradually over a week or two.

Can escitalopram cause problems?

Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the more common ones associated with escitalopram. The best place to find a full list of the side-effects which can be associated with your medicine, is from the manufacturer’s printed information leaflet supplied with the medicine. Alternatively, you can find an example of a manufacturer’s information leaflet in the reference section below. Speak with your doctor or pharmacist if any of the following continue or become troublesome.

Very common escitalopram side-effects (these affect more than 1 in 10 people) What can I do if I experience this?
Headache Drink plenty of water and ask your pharmacist to recommend a suitable painkiller. If the headaches continue, speak with your doctor
Feeling sick (nausea) Stick to simple meals – avoid fatty or spicy food
Common escitalopram side-effects (these affect less than 1 in 10 people) What can I do if I experience this?
Being sick (vomiting), tummy (abdominal) pain, diarrhoea, indigestion Stick to simple meals – avoid fatty or spicy food
Feeling dizzy, or sleepy Do not drive and do not use tools or machines while affected
Constipation Try to eat a well-balanced diet containing plenty of fibre, and drink several glasses of water each day
Dry mouth Try chewing sugar-free gum, or sucking sugar-free sweets
Unusual dreams, sleeping problems, tingling feelings, yawning, feeling hot, sweating, changes in appetite or weight, feeling restless or shaky, sexual problems If any becomes troublesome, speak with your doctor

If you experience any other symptoms which you think may be due to escitalopram, please speak with your doctor or pharmacist for further advice.

How to store escitalopram

  • Keep all medicines out of the reach and sight of children.
  • Store in a cool, dry place, away from direct heat and light.
  • You can use escitalopram drops for eight weeks after first opening the bottle. After this time, make sure you have a fresh supply to use.

Important information about all medicines

Never take more than the prescribed dose. If you suspect that you or someone else might have taken an overdose of this medicine, go to the accident and emergency department of your local hospital. Take the container with you, even if it is empty.

This medicine is for you. Never give it to other people even if their condition appears to be the same as yours.

If you are having an operation or any dental treatment, tell the person carrying out the treatment which medicines you are taking.

Do not keep out-of-date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you.

If you have any questions about this medicine ask your pharmacist.

Lexapro (Escitalopram) Signs, Symptoms, & Side Effects

Similar to many other antidepressant medications, Lexapro warns of an increased risk of suicide, with a higher risk for adults and teenagers who are younger than 24 years old. Suicidal thoughts may increase when first taking the medication or when there is a change in dosage.

There has also been research that links prenatal exposure to SSRIs with autism or developmental delays, with higher risks among newborns whose mothers were on SSRI medication early in their pregnancy.

Escitalopram has also been associated with weight gain due to large fluid retention and an increased appetite. It is recommended to maintain physical activity to manage weight gain while using Lexapro.

Certain side effects may occur, including:

  • Nausea
  • Diarrhea
  • Constipation
  • Changes in sex drive or function
  • Drowsiness
  • Unusual sweating
  • Dizziness
  • Heartburn
  • Stomach pain
  • Extreme tiredness
  • Dry mouth
  • Greater appetite
  • Flu-like symptoms, including sneezing and runny nose

Serious side effects can also occur, such as decreased interest in sex, easy bruising or bleeding, fever, confusion, fast or irregular heartbeat, severe muscle stiffness, extreme restlessness, panic attacks, aggressive behavior, impulsiveness, mania or extreme increase in talking, or worsening depression and anxiety. If you have any of these side effects, seek medical attention immediately.

Due to the increased level of serotonin in the brain, escitalopram and Lexapro can sometimes, although rarely, cause serotonin syndrome/toxicity. This risk increases when taking other medications that also increase serotonin. If symptoms such as hallucinations, loss of coordination, severe dizziness, nausea or diarrhea, twitching muscles, and unusual restlessness occur, seek medical help right away.

It is important to monitor progress while taking escitalopram or Lexapro. At the first sign of adverse side effects, schedule a doctor’s visit to reassess the dosage or to determine if the medication should be stopped altogether.

PMC

Author Response

Dr. Blanchfield raises an interesting phenomenon. When I describe the existing medical evidence that fails to support increasing SSRI dose beyond the minimal therapeutic dose, I often hear the retort, “What about my patients on high-dose SSRIs who consistently relapse when I try to lower the dose.” Of course research only addresses “average” effects of groups and cannot rule out that for any given individual a dose increase of his or her SSRI is responsible for producing a superior clinical response. However, we should be careful not to view the fact that a patient on high-dose SSRI relapses when the dose is lowered as validation that he or she requires the high dose to treat his or her depression in the first place. Antidepressant withdrawal relapse may be a completely separate phenomenon from the initial treatment effect. Important in this regard are studies conducted using specially concocted drinks that can rapidly reduce serotonin or noradrenaline/dopamine in the central nervous system of human subjects.1 Those studies have shown that neither depletion of serotonin nor noradrenaline/dopamine induce depression in nondepressed, unmedicated patients. However, depressed patients who have been stabilized on SSRI medications and continue to take it will experience rapid relapse of their depression when given a drink that depletes their serotonin but will not experience rapid depression from drinks that deplete their noradrenaline/dopamine. Conversely, patients who are on maintenance treatment with serotonin-norepinephrine reuptake inhibitor medication will relapse when given a drink that depletes noradrenaline/dopamine but not when given a drink depleting serotonin. From these studies, it seems that that treating a patient with an antidepressant induces physiological changes that make that patient “mood-dependent” on the neurotransmitter system that is stimulated by the antidepressant such that rapid depletion of that neurotransmitter induces a “rebound” worsening of mood. Patients who are on high-dose antidepressants may be experiencing a related phenomenon when their dose is lowered.

Can Lexapro cause weight changes?

Share on PinterestLexapro boosts serotonin levels, which may lead to weight gain.

A person may gain some weight when taking Lexapro. This can happen for different reasons. Lexapro boosts serotonin, which plays a role in controlling weight. The medication may increase appetite directly, or a person may begin to eat more as their depression or anxiety lessens.

Weight loss is a less common side effect, but it can happen as the body adjusts to the medication. Some people may also find that they have more energy or more desire to exercise as the medication relieves their depression. This symptom relief could also put a stop to unhealthy patterns of behavior, such as binge eating, which could lead to some weight loss.

The United States National Library of Medicine include increased appetite as one of the recognized side effects of Lexapro. Having a larger appetite usually results in a person eating more, which can lead to weight gain. However, some people taking Lexapro will experience none or only some of the side effects linked to this medication.

Depression and anxiety can both affect a person’s eating habits. They can cause someone to have less of an appetite, take less pleasure in food, or feel anxious about eating. As people receive treatment for their depression or anxiety, these symptoms should lessen or go away. This can increase a person’s enjoyment of food, or reduce any anxiety relating to eating.

A 2014 study in New England looked at weight changes over a 12-month period in people taking a range of antidepressants, including Lexapro. The researchers used citalopram as the reference drug for comparison.

All of the SSRIs in the study caused a gradual increase in weight. The only SSRI to cause some initial weight loss before weight gain was fluoxetine.

The average weight gain for Lexapro was less than 0.5 percent. The most significant weight gain occurred in young men and those who had a low body mass index (BMI) before starting treatment.

Research in 2017 looked at the role that SSRIs play in weight gain and found that specific risk factors increased the likelihood of a person gaining weight when taking these antidepressants. These factors included:

  • having a sedentary lifestyle
  • smoking
  • eating a diet high in processed meat, dairy, and refined carbohydrates

A 2011 study directly compared Lexapro with nortriptyline, which is an older tricyclic antidepressant. The authors found that Lexapro was the less likely of the two drugs to cause weight gain.

It is not completely clear why taking SSRIs such as Lexapro can lead to weight gain. More research is necessary to provide a definite answer.

Five Signs Your Antidepressant is Not Working

By Kayt Sukel

You’ve been diagnosed with depression and prescribed an antidepressant medication. You’ve been taking your prescription for a few weeks—but are unsure whether or not it is working. It can be frustrating when your antidepressant is not working. It’s important to note that antidepressant medications usually take two to 12 weeks to start working, with an apex around six to eight weeks. It may be that you just need to give the regimen more time. But if you are still questioning your treatment, there are a few clues that can help you decide whether to wait it out or head back to the clinic.

1. You experience no relief from your depressive symptoms. Jonathan Stevens, M.D., M.P.H., Clinical Director of Outpatient Services at the Menninger Clinic in Houston, Texas, says that the goal of antidepressant treatment is to put depressive symptoms in remission—though sometimes that is a lofty goal. But the drug should be helping to alleviate your blues. “If you are going on six weeks and see no effect, or only a very small effect when it comes to helping those symptoms, that’s usually a sign that you need to switch to a different antidepressant,” he says. “It’s worth talking to your doctor.”

2. Your depression gets worse. Sometimes, it’s not a matter of little or no relief. Sometimes, antidepressant medications can make a depressive episode even worse. Stevens says that if your depression is getting worse, if you are feeling agitated, “uncomfortable in your own skin,” or unable to get out of bed in the morning, you need to see your physician immediately. “We’re still at the state where the medicines we choose have a lot to do with the individual provider’s preference. It’s not always chosen to fit a patient’s biology, so we don’t always get it right the first time,” he says. “But we can now do some genetic testing to determine which medicines might respond better to your personal biology based on your metabolism. That can be a big help.”

3. You experience a sudden surge of energy—while still battling the blues. Some have speculated that this new-found energy, often experienced when starting on an antidepressant and while still suffering from depressive symptoms, can cause patients to behave in dangerous ways. Stevens says this is a significant concern. He recommends returning to your doctor if you feel this way.

4. You are overwhelmed by the drug’s side effects. Stevens cautions that side effects are fairly common—which is why it’s so important that clinicians try to educate patients about what to expect before starting a new medication. “All drugs have side effects. And, unfortunately, sometimes those side effects come on before the beneficial effects,” he says. “But if you are feeling wild mood swings, you aren’t sleeping, or feel like you’re crawling out of your skin, or have other unpredictable side effects, those are things your doctor needs to be aware of right away.” Genetic testing can also call out which medications are likely to cause significant side effects for a particular patient.

5. You start suffering from violent mood swings. This is a significant red flag, says Stevens. “Depression and bipolar disorder are not the same disease. Sometimes people with bipolar disorder come in reporting a significant depression. But antidepressant medications are much riskier for this population,” he says. “If you are feeling excess feelings of restlessness, silly giggling, seething irritability or anger—really out of character behaviors—you need to go back to your doctor.”

  • Baldwin DS, Nair RV. Escitalopram in the treatment of generalized anxiety disorder. Expert Review of Neurotherapeutics. 2005;5:443–9.
  • Black DW, Wesner R, Bowers W, et al. Acute treatment response in outpatients with panic disorder: high versus low depressive symptoms. Ann Clin Psychiatry. 1995;7:181–8.
  • Bridge JA, Iyengar S, Salary CB, et al. Clinical response and risk for reported suicidal ideation and suicide attempts in pediatric antidepressant treatment. JAMA. 2007;297:1683–96.
  • Burke WJ, Gergel I, Bose A. Fixed dose trial of the single isomer SSRI escitalopram in depressed outpatients. J Clin Psychiatry. 2002;63:331–6.
  • Cassano GB, Petracca A, Perugi G, et al. Clomipramine for panic disorder: the first 10 weeks of along-term comparisons with imipramine. J Affect Disord 1988
  • Ceglia I, Acconcia S, Fracasso C, et al. Effects of chronic treatment with escitalopram or citalopram on extracellular 5-HT in the prefrontal cortex of rats: role of the 5-HT1A Receptors. British Journal of Pharacology. 2004;142:469–78.
  • Cowley DS, Ha EH, Roy-Byrne PP. Determinants of pharmacologic treatment failure in panic disorder. J Clin Psychiatry. 1997;58:555–61.
  • Davidson JR, Bose A, Korotzer A, et al. Escitalopram in the treatment of generalized anxiety disorder: double-blind, placebo-controlled, flexible-dose study. Depression and Anxiety. 2004;19:234–40.
  • Garakoni H, Zitirin CM, Klein DF. Treatment of panic disorder with imipramine alone. Am J Psychiatry. 1984;141:446–8.
  • Goldberg JF, Truman CJ. Antidepressant-induced mania: an overview of current controversies. Bipolar Dis. 2003;5:407–20.
  • Goddard AW, Charney DS. Toward an integrated neurobiology of panic disorder. J Clin Psychiatry. 1997;58 (Suppl 2):4–11.
  • Goodwin RD, Roy-Byrne P. Panic and suicidal ideation and suicide attempts: results from the national comorbidity survey. Depress Anxiety. 2006;23:124–32.
  • Gorman JM, Kent JM, Sullivan GM, et al. Neuroanatomical hypothesis of panic disorder, revisited. Am J Psychiatry. 2000;157:493–505.
  • Grove G, Coplan JD, Hollander E. The neuroanatomy of 5-HT dysregulation and panic disorder. J of Neuropsychiatry and Clin Neurosciences. 1997;9:198–207.
  • Hirschfeld RMA, Vornik LA. Newer antidepressants: review of efficacy and safety of escitalopram and duloxetine. J Clin Psychiatry. 2004;65(Suppl 4):46–52.
  • Hogg S, Michan L, Jessa M. Prediction of anti-panic properties of escitalopram in the Dorsal Periaqueductal Grey Model of Panic Anxiety. Neuropharmacology. 2006;51:141–5.
  • Kessler RC, Berglund P, Demler O, et al. Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62:593–602.
  • Kessler RC, Chiu WT, Demler O, et al. Prevalence, Severity, and Comorbidity of 12-Month DSM-IV Disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62:617–27.
  • Lader M, Stender K, Burger V, et al. Efficacy and tolerability of escitalopram in 12- and 24-week treatment of social anxiety disorder. Depress Anxiety. 2004;19:241–8.
  • Lader M. Management of panic disorder. Expert Rev of Neurother. 2005;5:259–66.
  • Lepola UM, Wade AG, Leinonen EV. A controlled, prospective, 1-year trial of citalopram in the treatment of panic disorder. J Clin Psychiatry 1998
  • Lexapro St. Louis, MO: Forest Pharmaceuticals, Inc; 2007.
  • Mansari M, Wiborg O, Mnie-Filali O, et al. Allosteric modulation of the effect of escitalopram, paroxetine and fluoxetine: In-vitro and in-vivo studies. Int J Neuropsychopharmacol. 2007;10:31–40.
  • Maron E, Shlik J. Serotonin Function in Panic Disorder: Important, But Why? Neuropsychopharmacology. 2006;31:1–11.
  • Olie JP, Tonnoir B, Menard F, et al. A prospective study of escitalopram in the treatment of major depressive episodes in the presence or absence of anxiety. Depress Anxiety. 2006 Oct 13
  • Perna G, Bertani A, Caldirola D, et al. A comparison of citalopram and paroxetine in the treatment of panic disorder: a randomized, single-blind study. Pharmacopsychiatry. 2001;34:85–90.
  • Pollack MH, Marzol PC. Panic: course, complications and treatment of panic disorder. J Psychopharmacol. 2000;14:S25–S30.
  • Pollack MH. The pharmacotherapy of panic disorder. J Clin Psychiatry. 2005;66(Suppl 4):23–27.
  • Rampello L, Alvando A, Raffaele R, et al. New possibilities of treatment for panic attacks in elderly patients: escitalopram versus citalopram. J Clin Psychopharmacol. 2006;26:67–70.
  • Sanchez C, Bergqvist PBF, Brennum LT, et al. Escitalopram, the s-(+)-enantiomer of citalopram, is a selective serotonin reuptake inhibitor with potent effects in animal models predictive of antidepressant and anxiolytic activities. Psychopharmacology. 2003;167:353–62.
  • Sanchez C, Bogeso KP, Ebert B, et al. Escitalopram versus citalopram: the surprising role of the R-enantiomer. Psychopharmacology. 2004;174:163–76.
  • Sayar MK, Cetin M. Escitalopram in panic disorder: an open flexible-dose study. World J Biol Psychiatry. 2004;5(Suppl 1):133.
  • Simon NM, Fischmann D. The implications of medical and psychiatric comorbidity with panic disorder. J Clin Psychiatry. 2005;66(Suppl 4):8–15.
  • Stahl SM. Mechanism of action of serotonin selective reuptake inhibitors: serotonin receptors and pathways mediate therapeutic effects and side effects. J Affect Disord. 1998;51:215–25.
  • Stahl SM, Gergel I, Li D. Escitalopram in the treatment of panic disorder: a randomized, double-blind, placebo-controlled trial. J Clin Psychiatry. 2003;64:1322–27.
  • Sullivan GM, Oquendo MA, Simpson N, et al. Brain serotonin 1A receptor binding in major depression is related to psychic and somatic anxiety. Biol Psychiatry. 2005;58:947–54.
  • Townsend MH, Bologna NB, Barbee JG. Heart rate and blood pressure in panic disorder, major depression, and comorbid panic disorder and major depression. Psychiatry Res. 1998;79:187–90.
  • Wade AG, Lepola U, Koponen HJ, et al. The effect of citalopram in panic disorder. Br J Psychiatry. 1997;170:549–53.
  • Witchel HD, Hancox JC, Hutt DJ. Psychotropic drugs, cardiac arrhythmia, and sudden death. J Clin Psychopharm. 2003;23:58–77.
  • Yamada M, Yasuhara H. Clinical pharmacology of MAO inhibitors: safety and future. Neurotoxicol. 2004;25:215–21.

What Are the Side Effects of Lexapro?

SSRIs, including Lexapro, are tolerated well compared to other types of antidepressants. In general, you may have more side effects if you take a higher dosage of the drug. At a high dosage, Lexapro is more likely to cause gastrointestinal side effects, such as diarrhea.

Common side effects

The side effects of Lexapro seem to be the same in both men and women. The side effects are slightly different for adults and children.

Adult side effects can include:

  • nausea
  • sleepiness
  • weakness
  • dizziness
  • anxiety
  • sleeping trouble
  • sexual problems, such as decreased sex drive and erectile dysfunction
  • sweating
  • shaking
  • loss of appetitive
  • dry mouth
  • constipation
  • infection
  • yawning

The side effects for children and adolescents can include the above, plus:

  • increased thirst
  • abnormal increase in muscle movement or agitation
  • nosebleeds
  • trouble urinating
  • heavy menstrual periods
  • slowed growth and weight change

There have been some cases of decreased appetite and weight loss with the use of Lexapro in children and adolescents. Your child’s doctor may check their height and weight during treatment.

People with depression tend to have a low appetite and reduced body weight. In adults, some sources say Lexapro may cause a small amount of weight gain. However, if you gain weight, your weight may just be evening out because your depression is better managed and your appetite has returned. Other people lose weight when they’re taking Lexapro. The increase in serotonin may lead to loss of appetite.

Most of these side effects are mild. They should eventually go away on their own without treatment. If they’re more severe or don’t go away, tell your doctor.

Boxed warning side effects

A boxed warning is the most serious warning from the U.S. Food and Drug Administration (FDA).

Lexapro may increase suicidal thoughts or actions. This risk is higher in in children, teenagers, or young adults. This is more likely to happen within the first few months of treatment or during dosage changes.

Call your doctor right away if you have any of the following symptoms, or call 911 or local emergency services if the symptoms are new, worse, or worrisome:

  • attempts to commit suicide
  • acting on dangerous impulses
  • aggressive or violent actions
  • thoughts about suicide or dying
  • new or worse depression
  • new or worse anxiety or panic attacks
  • feeling restless, angry, or irritable
  • trouble sleeping
  • increased activity (doing more than what is normal for you)
  • other unusual changes in your behavior or mood

Other serious side effects

Lexapro can also cause other serious side effects. Call your doctor right away if you have serious side effects. Call 911 or local emergency services if your symptoms feel life-threatening or if you think you’re having a medical emergency.

Severe allergic reactions

You should not take Lexapro if you’re allergic to it, its ingredients, or the antidepressant Celexa. Symptoms can include:

  • breathing trouble
  • swelling of your face, tongue, eyes, or mouth
  • severe rash, hives (itchy welts), or blisters that may come on with fever or joint pain

Seizures or convulsions

There have been reports of some people having seizures while taking Lexapro. People with a history of seizures are at higher risk.

Serotonin syndrome

This is a serious condition. It happens when the levels of serotonin in your body get too high. It’s more likely to occur if you also take other drugs that increase serotonin, such as other antidepressants or lithium. Symptoms can include:

  • agitation
  • hallucinations (seeing or hearing things that aren’t real)
  • coma (loss of consciousness)
  • coordination problems, overactive reflexes, or muscle twitching
  • racing heart rate
  • high or low blood pressure
  • sweating or fever
  • nausea, vomiting, or diarrhea
  • muscle stiffness

Low salt levels

Lexapro may cause low salt levels in your body. This may be more likely to occur in seniors, people who take water pills, or people who are dehydrated. This side effect may cause:

  • headache
  • confusion
  • trouble concentrating
  • thinking or memory problems
  • weakness
  • unsteadiness that can lead to falls
  • seizures

Manic episodes

If you have bipolar disorder, Lexapro may cause you to have a manic episode. Taking Lexapro without another drug for bipolar disorder may trigger an episode. Symptoms can include:

  • greatly increased energy
  • severe sleeping trouble
  • racing thoughts
  • reckless behavior
  • unusually grand ideas
  • excessive happiness or irritability
  • talking quickly or more than normal

Vision problems

Lexapro may dilate your pupils. This may trigger a glaucoma attack, even if you don’t have a history of eye problems. Symptoms can include:

  • eye pain
  • changes in your vision
  • swelling or redness in or around your eye

Side effects with other health conditions

If you have certain health conditions, you likely should not take Lexapro. In some cases, your doctor may lower your dosage or watch you more closely during your treatment with it. Tell your doctor if you have any of the following health conditions before taking Lexapro.

  • A history of suicidal thoughts or behaviors—Lexapro can increase the risk of suicidal thinking and behavior, especially in children, teens, and young adults.
  • Bipolar disorder—if you take Lexapro without taking other medications for bipolar disorder, Lexapro may bring on a manic episode.
  • Seizures—this drug may cause seizures and make your seizure disorder worse.
  • Glaucoma—this drug may bring on a glaucoma attack.
  • Low salt levels—Lexapro can further lower your salt levels.
  • Pregnancy—it isn’t known if Lexapro will harm your unborn baby.
  • Breastfeeding—Lexapro may pass into breast milk and cause side effects in a child who is breastfed.

Panic Disorder

Panic Attack

A panic attack is a sudden surge of overwhelming anxiety and fear that can happen to anyone at any time during a normal activity, such as going to work or to a store, riding in an elevator or watching TV. They can even occur when a person is asleep.

After onset, most panic attacks peak after 10 to 20 minutes, but the episode can last for as long as an hour or more. At least 20% of Americans will suffer from a panic attack at some point in their lives and it may be a one-time occurrence. Women are twice as likely to experience them as men.

A panic attack can result from the stress of a life-changing event, such as the loss of a loved one, a job or relationship change, having a baby, etc.

Symptoms

Someone who is suffering a panic attack may believe he is having a heart attack and may seek medical treatment, because the symptoms of both are similar. He may have chest pain, shortness of breath and a pounding or racing heart. This is because when facing stressful situations, the body releases adrenalin to fuel the “fight or flight” impulse. This causes several changes in the body. It speeds up breathing and heart rate to take in more oxygen so the body can convert more sugar into energy to confront or escape from danger. The senses also become more acute, muscles can become tense and stiff, the digestion slows and perspiration increases.

Other symptoms include:

  • Dizziness or Lightheadedness
  • Feeling out of control
  • Nausea
  • Shaking
  • Feeling disconnected from reality
  • Tingling sensations
  • Fear of impending doom or dying
  • Feeling of choking
  • Excessive sweating, hot flashes or chills

Panic Disorder can develop when a person who experiences multiple panic attacks or begins to fear having another attack (anticipatory anxiety). These attacks can have lasting effects that may interfere with work, family obligations and social situations. For example, people with panic disorder may associate their panic attacks to situations, objects or locations where their previous attacks have occurred. This may cause them to have anxiety about normal activities, such as grocery shopping or driving.

Panic Disorder with Agoraphobia

Some people with panic disorder may develop agoraphobia, which is the intense fear of situations and places that they think might lead to another panic attack. Home becomes a safe haven from the embarrassment of having a panic attack in a public place, or being in a place where help may not be available.

Causes

Panic disorder may occur as a result of another disorder, such as a social phobia, schizophrenia, and post traumatic stress disorder (PTSD) or depression. Genetics have been shown to be a factor as it may be passed down by a parent. Certain drugs can cause panic attacks, too. Abuse of drugs and alcohol can contribute to panic disorder and people with chronic pain are prone to panic attacks, although it is unclear whether it is due to the anxiety caused by pain or the medication they are using to treat it.

Diagnosis

Before a panic attack can be diagnosed, a physician will order blood tests and x-rays to rule out other medical conditions which can cause panic attack symptoms, such as: heart attack, mitral valve prolapse, hyperthyroidism, hypoglycemia or stimulant drugs.

Treatment

Once a physical cause is ruled out, the individual and practitioner can discuss the severity of the condition. In many cases medication is used along with cognitive-behavioral therapy. Medication may be prescribed to help with anxiety. Cognitive behavior therapy helps panic attack sufferers recognize irrational fears and how to deal with them.

Cognitive Behavior Therapy

Cognitive behavior therapy is used to help clients learn how negative thoughts (cognitions), contribute to anxiety. Behavior therapy helps clients learn how to respond to anxiety-causing situations or physical sensations, by replacing them with healthier behaviors.

Exposure therapy helps clients cope with situations that are causing panic attacks. For example, if someone has had a panic attack in an elevator, he may relate the attack to going into an elevator. The panic attack has now been erroneously connected to the elevator, but it doesn’t guarantee a panic attack will not happen elsewhere. So, avoiding elevators does not eliminate the possibility of having another panic attack. Cognitive behavior therapy is used to help the individual disconnect an attack with a place. It also helps individuals deal with intervals of being in situations that cause anxiety for gradually longer periods of time.

Lifestyle Changes

Reducing stress through exercise and deep breathing; eating healthy and getting adequate sleep all can help reduce panic attacks.

Medications

Below are different types of drugs that may be used in combination with psychotherapy to help control symptoms.

  • Antidepressant Drugs
  • Selective Serotonin re-uptake inhibitors (SSRIs)
    These are the most commonly prescribed medications used for anxiety disorders. SSRIs work by regulating the activity of Serotonin, a neurotransmitter which is a chemical substance that carries messages between nerve cells. Serotonin affects mood, sleep, temperature, learning, memory, social behavior and several other functions. SSRIs correct serotonin imbalances by reducing the re-uptake (re-absorption) of serotonin into the brain and enabling it to build up. Increasing the level of serotonin in the brain increases brain activity, which in turn boosts mood in people with OCD, depression, and some types of anxiety disorders. Examples of SSRI antidepressants include:
    • Citalopram (Celexa);
    • Escitalopram (Lexapro, Cipralex)
    • Paroxetine (Paxil, Seroxat) – Also used to treat panic disorder, OCD, social anxiety disorder, generalized anxiety disorder and PTSD;
    • Fluoxetine (Prozac)– Also used to treat OCD, bulimia, and panic disorder.
    • Fluvoxamine (Luvox)–Although primarily used in the treatment of OCD, a doctor may prescribe it for depression.
    • Sertraline (Zoloft, Lustral)– Also used to treat panic disorder, OCD, PTSD, social anxiety disorder, premenstrual dysphoric disorder.
  • Serotonin-norepinephrine re-uptake inhibitors (SNRIs)
    These medications influence the activity of brain chemicals (neurotransmitters) thought to play a role in anxiety disorders. They work by increasing the levels of the neurotransmitters serotonin and norepinephrine by blocking their re-absorption into cells in the brain. Examples of antidepressants include:
    • Desvenlafaxine (Pristiq): Similar to Venlafaxin;
    • Duloxetine (Cymbalta):
    • Venlafaxine (Effexor): Also used to treat generalized anxiety disorder, panic disorder and social anxiety disorder.
  • Anti-anxiety Drugs
  • Benzodiazepines
    Examples include lorazepam (Ativan), diazepam (Valium), chlordiazepoxide (Librium) and alprazolam (Xanax). This class of drugs is frequently used for short-term management of anxiety. Benzodiazepines are effective in promoting relaxation and reducing muscular tension and other physical symptoms of anxiety. Long-term use may require increased doses to achieve the same effect, which may lead to problems related to tolerance and dependence. They can be habit forming and can cause a number of side effects, including drowsiness, reduced muscle coordination, and problems with balance and memory.

About the author

Leave a Reply

Your email address will not be published. Required fields are marked *