Lexapro FAQs

About Lexapro
How to Use Lexapro
Lexapro Pharmacology
Lexapro FAQs
Lexapro Side-Effects
Recovery Tips
Site Map

Online Depression Test
Depression Articles

Anxiety-Panic
Depression

send this page to a friend

Starting Lexapro and Dosage Issues

Below are the answers to frequently asked questions about the SSRI antidepressant Lexapro (Escitalopram Oxalate). The answers are provided by HealthyPlace.com Medical Director, Harry Croft, M.D., a board-certified psychiatrist.

As you are reading these answers, please remember these are "general answers" and not meant to apply to your specific situation or condition. Keep in mind that editorial content is never a substitute for a visit to a health care professional.

What are all the uses, on-and-off label, that Lexapro is being prescribed for?

HealthyPlace.com Video

Antidepressants: Who needs them, for how long? And what is the best way to treat depression for the short and long-term?
An interview with psychiatrist and HealthyPlace.com Medical Director, Harry Croft, M.D.

A: First, it is important to understand "on" vs "off label" uses of a medication. "On label" means that the FDA has approved the drug for this use as a result of reviewing the scientific study data on the effectiveness and safety of the drug. Once the drug is "approved" for a specific use, it is permissable for physicians to prescribe the medications for other conditions for which it is useful, but not "officially approved." Often, there are significant studies which show a medication is useful and safe for other conditions, but due to costs involved in getting formal FDA approval for these other conditions, a pharmaceutical company may choose not to go for this "formal approval" indication.

Lexapro has been "approved" by the FDA in the U.S. for the treatment of depression in adults. However, there is information suggesting that it is also useful for depression in children and adolescents, as well as for the treatment of anxiety disorders such as panic disorder, generalized anxiety disorder, social anxiety disorder and obsessive-compulsive disorder. There is also reason to believe that it may be useful for helping women with symptoms of premenstural dysphoric disorder (PMDD - PMS with significant emotional symptoms) and even impulse control problems like anger and irritability, compulsive shopping or obsessive spending, etc.

Some of these indications (eg panic, social anxiety and generalized anxiety disorder) have stronger back up studies than others. Other SSRIs have been approved by the FDA for one or another of the uses mentioned above and there is reason to believe the class, as a whole, may be useful for these conditions.

What is the difference between Lexapro and the other SSRIs and other antidepressants? How does one determine if Lexapro or another antidepressant would be best for them?

A: Lexapro is very effective in the treatment of depression. Physicians generally chose which antidepressant to use for a particular patient based upon factors such as side effects for that particular patient, costs and positive mindset.

In my experience, Lexapro appears to have fewer side effects, especially sedation and weight gain than the other SSRI's and seems to work in most patients a bit quicker than the other SSRI's. If given in 20mg tablets and cut in half for 10mg dose, it is less costly than other SSRI's and seems to be tolerated better in most patients than other SSRI's. However, some patients respond better to one SSRI than the others and, as of now, we have no way of knowing in advance which one SSRI will work best in a particular patient.

The other advantage of Lexapro is "ease of use," which means that most patients seem to respond to the starting dose of 10mg so that no dose change is necessary in these patients. This is beneficial for most patients because the starting dose is the dose that works over time.

What dose of Lexapro should a patient be started at and how do you know if the dosage should be increased or decreased? And when the dosage is increased or decreased, what does that do to your body and what does that make you feel like? What are the minimum and maximum dosages?

A: Most patients are started at 10 mg/day. Some patients might be started at 5 mg (especially those with severe anxiety disorder, those old or ill from other medical conditions), but most start at either one 10mg tablet, or half of a 20mg tablet. Usually the medication is taken once a day, most commonly in the morning, but some prefer to take it in the evening or at noontime.

From an effectiveness standpoint, it does not matter when during the day the medication is taken as it is the 24-hour dose only that seems to matter. Although side effects are not that common, some patients get either slightly sedated or energized by the medication, and these side effects for that particular patient may guide the time of day the tablet is taken (sedated-in the evening, energized-in the morning).

Generally the starting dose of 10mg is the ongoing dose for most patients. It is usually best to wait 3-8 weeks before deciding to increase the dose. An increase would be necessary if the medication is only partially effective at reducing the depressive symptoms. Although Lexapro seems to work in many patients a bit faster than other antidepressants, it still may take 3-8 weeks to fully "kick in" for the full antidepressant effect.

A decrease in dosage is generally suggested for side effects that do not go away in 2 weeks or so. (Most side effects, like nausea, indigestion, diarrhea, headache, slight increase in anxiety do go away within 2 weeks).

After the initial disappearance of side effects, they usually are gone for the duration of medication usage. However, on increasing the dose, the side effect may return for a brief period of time (usually no more than a day or two).

The minimum dose for most people is 10 mg (though a few may respond at 5 mg), and the maximum is generally 20mg (though a very few may require 30mg (higher than the FDA recommended top dose).

When you first start Lexapro, what should that feel like - physically and emotionally?

A: Often, when first taking Lexapro, a patient might feel little change, unless there are some initial side effects (which generally disappear after 7-14 days). Sometimes "positive expectations" (placebo effect) cause patients to feel better immediately, although for most patients it takes at least a week or two before feeling any improvement, and can take up to 3 months for a complete recovery effect to occur. Physical side effects will be discussed elsewhere. In general, emotional improvement is gradual, and realized in retrospect by looking back over the past several days and noting "you know, I am starting to feel less hopeless, despondent and depressed."

It is also common to begin to have some "good" days only to have them followed by some "not so good" ones. Patients should not feel discouraged by the "blue" days, but rather encouraged by the "good ones" instead, as they indicate that recovery is beginning.

What if you miss a dose? How will that make you feel and what should you do about it?

A: For most patients, one missed dose of Lexapro doesn't cause many symptoms, however, missing more than one day in a row can cause "serotonin discontinuation symptoms;" the most common being flu-like symptoms, muscle aches, vivid nightmarish dreams, and increasing anxiety. These discontinuation symptoms generally last 3-5 days and go away on their own. Although they can make a person feel fairly uncomfortable and frightened, they are generally not serious. If it is the same day when you realize you have missed a dose, take it then. If it is the next day, take the usual dose for that day. In general, it is not necessary to "catch up" by taking extra doses to make up for the one missed. So the point is try not to miss doses of medication, take them daily and regularly for at least 6 months after recovery from your depressive symptoms.

One other word of caution: always consult with your physician before discontinuing your antidepressant medication.

If you are switching from another antidepressant to Lexapro or vice versa, what should you keep in mind? What is entailed in the switchover? Can you switch from Celexa to Lexapro without a waiting period?

A: Although several antidepressants work by increasing the effectiveness of the brain neurotransmitter Serotonin, these medications from a structural chemical standpoint do not look alike. Therefore, one SSRI may work in a single patient, whereas another SSRI (working on the same brain "juice" Serotonin) may not work for that patient, and thus a switch may be necessary. Studies show that up to 50% of patients not responding to one SSRI may respond to another.

In general, patients can be switched from one SSRI to another without a waiting period in-between; however, due to Serotonin discontinuation symptoms, it is probably best to taper off one SSRI instead of just stopping it abruptly. I generally start patients on Lexapro while I taper off the other antidepressant, but other physicians may suggest tapering off the first, before starting the second. There is very little danger in overlapping the drugs for a short time, however.

Theoretically, since Lexapro is the "child" of the "parent" Celexa, it should be possible to switch a patient directly from Celexa (whose usual dose is 20-40mg) to Lexapro (usual dose 10-20mg), but some patients require tapering off of Celexa even when starting on Lexapro. I have some patients doing quite well on Celexa who did not respond as well to Lexapro (I still can't figure out why), and for this reason the makers of Lexapro do not, in general, suggest switching from Celexa to Lexapro if the patient is doing well on Celexa.

Lexapro FAQS

Starting Lexapro and Dosage Issues

HealthyPlace.com Video

RELATED LINKS AND INFO