Escitalopram is an antidepressant of the selective serotonin reuptake inhibitor (SSRI) class. It is mainly used to treat depression (MDD) and certain anxiety disorders: general anxiety disorder (GAD), social anxiety disorder (SAD), obsessive-compulsive disorder (OCD), and panic disorder with or without agoraphobia.
Common side effects include trouble sleeping, nausea, sexual problems, and feeling tired.
A person taking Lexapro may experience some weight gain, especially with long-term use. There are many reasons this may occur. One is that Lexapro increases serotonin levels, and serotonin plays a role in weight control. Additionally, Lexapro may increase a person’s appetite, which usually leads to eating more and gaining weight.
More serious side effects may include suicide in people under the age of 25.
Caution should be used when taking cough medicine containing dextromethorphan (DXM) as serotonin syndrome, liver damage, and other negative side effects have been reported.
Escitalopram discontinuation, particularly abruptly, may cause certain withdrawal symptoms such as "electric shock" sensations (also known as "brain shivers" or "brain zaps"), dizziness, acute depressions and irritability, as well as heightened senses of akathisia.
Excessive doses of escitalopram usually cause relatively minor untoward effects such as agitation and tachycardia. However, dyskinesia, hypertonia, and clonus may occur in some cases.
There is a tentative association of SSRI use during pregnancy with heart problems in the baby. Their use during pregnancy should thus be balanced against that of depression.
Mechanism of action
Escitalopram increases intrasynaptic levels of the neurotransmitter serotonin by blocking the reuptake of the neurotransmitter into the presynaptic neuron. Of the SSRIs currently on the market, escitalopram has the highest selectivity for the serotonin transporter (SERT) compared to the norepinephrine transporter (NET), making the side-effect profile relatively mild in comparison to less-selective SSRIs.
Escitalopram is a substrate of P-glycoprotein and hence P-glycoprotein inhibitors such as verapamil and quinidine may improve its blood-brain penetrability. In a preclinical study in rats combining escitalopram with a P-glycoprotein inhibitor, its antidepressant-like effects were enhanced.[
Escitalopram, similarly to other SSRIs (with the exception of fluvoxamine), inhibits CYP2D6 and hence may increase plasma levels of a number of CYP2D6 substrates such as aripiprazole, risperidone, tramadol, codeine, etc. As much of the effect of codeine is attributable to its conversion (10%) to morphine its effectiveness will be reduced by this inhibition, not enhanced. Being a SSRI, escitalopram should not be given concurrently with MAOIs or other serotonergic medications.