Lexapro Side Effects, Use, and Risks

Angie Doel
Calendar icon Last Updated: 12/6/2021

Reading Time: 7 minutes

Lexapro (escitalopram) is a selective serotonin reuptake inhibitor (SSRI) prescribed to treat depression and generalized anxiety disorder in adults. SSRIs like Lexapro are non-addictive; however, you can become dependent on it, which means you may experience withdrawal or “antidepressant discontinuation syndrome” when you suddenly stop taking it. This is a normal adaptation to taking the medication and isn’t anything to be concerned about. Like most medications, there are several side effects and risks associated with Lexapro use, though it is generally considered safe.1

What is Lexapro and How is it Used?

Lexapro, which comes in pill or liquid form, is a prescription antidepressant medication that works to help restore the balance of serotonin in the brain.2 Using Lexapro may improve your energy and feelings of well-being and decrease nervousness.1

Lexapro treats major depressive disorder (MDD) and generalized anxiety disorder (GAD).1 It can also help when prescribed “off-label” to treat:3

  • Obsessive-compulsive disorder (OCD)
  • Eating disorders
  • Panic disorder
  • Posttraumatic stress disorder (PTSD)
  • Premenstrual dysphoric disorder (PMDD)

“Off-label” means the Food and Drug Administration (FDA) has not approved the drug for these conditions, but physicians may prescribe them at their discretion anyway.3

Lexapro is generally effective and has fewer side effects than other antidepressants like monoamine oxidase inhibitors (MAOIs).2

Lexapro Side Effects

Lexapro may cause side effects, even if you take the medication exactly as prescribed. Tell your doctor if any of these symptoms are severe or do not go away:1,2

  • Nausea
  • Diarrhea
  • Constipation
  • Changes in sex drive or ability
  • Drowsiness
  • Increased sweating
  • Dizziness
  • Heartburn
  • Stomach pain
  • Excessive tiredness
  • Dry mouth
  • Decreased appetite
  • Weight loss
  • Flu-like symptoms
  • Runny nose
  • Sneezing

Some Lexapro side effects can be severe or dangerous. If you experience any of these symptoms, call your doctor immediately:1,2

  • Unusual excitement or agitation
  • Seeing things or hearing voices that do not exist (hallucinating)
  • Rash
  • Hives or blisters
  • Itching
  • Fever
  • Joint pain
  • Fever or sweating
  • Confusion
  • Fast or irregular heartbeat
  • Severe muscle stiffness or twitching
  • Abnormal bleeding or bruising
  • Unsteadiness or clumsiness
  • Problems with thinking, concentration, or memory

That is not an exhaustive list of Lexapro side effects. Call your doctor if you have any unusual problems while taking this medication. Misusing Lexapro increases the risk of experiencing unpleasant and potentially dangerous side effects, such as:2

  • Coma
  • Delirium
  • Increasingly worsening heart pace (dysrhythmia)
  • Involuntary eye movement
  • Respiratory distress
  • Seizures
  • Unconsciousness
  • Swelling of the face, throat, tongue, lips, or eyes

Risks of Lexapro Use

There are risks even if you take Lexapro as directed, but the risks increase when you use this medication in a way other than prescribed, particularly when mixing it with other substances.4

The majority of patients that are prescribed antidepressants don’t misuse them. However, people with a history of substance use issues might be more likely to misuse them.4

Although Lexapro addiction remains rare, people may take larger doses in an attempt to improve their mood more or experience euphoria.4

Lexapro can get misused in the following ways:4

  • Taking more Lexapro than was prescribed by your doctor
  • Taking someone else’s Lexapro
  • Buying Lexapro from friends, family members, or dealers
  • Forging prescriptions for Lexapro

Lexapro is generally safe for most people. However, you should be aware of certain risks associated with taking Lexapro, including an increased risk of suicide, serotonin syndrome, and hyponatremia.1

Lexapro can increase suicidal thoughts or actions in children, teenagers, and young adults under age 25.5 For this reason, the Food and Drug Administration (FDA) requires that all antidepressants carry black box warnings.5 These warnings are used only for serious safety concerns.5

One of the main goals of Lexapro is to reduce suicide risk over time. However, if you start to have suicidal thoughts or ideation at the beginning of Lexapro treatment, contact emergency medical services or your doctor immediately.5

Mixing Lexapro and Other Substances

Lexapro should not get combined with drugs that increase your risk of bleeding. These drugs include nonsteroidal anti-inflammatory drugs (NSAIDs), warfarin, other blood thinners, or aspirin. If taken together, these combinations can contribute to your risk of gastrointestinal bleeding or other bleeding problems.1

Combining Lexapro with other antidepressants, particularly monoamine oxidase inhibitors (MAOIs), should be avoided to prevent serious side effects. If you stop taking Lexapro, you must wait five weeks before taking an MAOI. If you discontinue the use of MAOIs, you must wait two weeks before taking Lexapro.1 Serious side effects can occur if the use of the two drugs overlaps, including:1

  • Agitation or irritability
  • Restlessness
  • Seizures or severe convulsions
  • Confusion
  • High body temperature
  • Stomach or intestinal problems
  • Extremely high blood pressure

Lexapro allows serotonin to accumulate in the brain outside of neurons, increasing your chances of developing serotonin syndrome. This condition occurs when high levels of serotonin accumulate in your body.6

Most often, serotonin syndrome is the result of combining two medications that increase serotonin levels.6 Examples of these include fentanyl, other antidepressants, the herbal supplement, St. John’s wort, and amphetamines.6 Signs of serotonin syndrome include:6

  • Sweating
  • High fever
  • Confusion
  • Rapid heart rate
  • Nausea and vomiting
  • Tremors
  • Dangerous changes in blood pressure
  • Lack of coordination
  • Restlessness
  • Anxiety or agitation
  • Coma

If you have any of these symptoms, contact emergency medical services immediately.

Lexapro and alcohol should not be combined. Alcohol can worsen the symptoms of depression, which can become dangerous if you take Lexapro to treat it.1 Drinking alcohol while on Lexapro may decrease the efficacy of Lexapro (it may not work as well to treat your condition), increase anxiety, worsen depression, and increase side effects such as drowsiness, dizziness, and coordination problems. Lexapro can also increase the negative effects of alcohol.4 Because of these effects, please talk with your doctor about your history of depression and alcohol use before taking Lexapro.

Overdose Risk & Signs

The symptoms of Lexapro overdose will typically be mild and non-specific in the first hour or two and progressively worsen over time.4 Some signs of Lexapro overdose include:4

  • Agitation
  • Diarrhea
  • Drowsiness
  • Dry mouth
  • Headache
  • Nausea
  • Vomiting

One of the earliest red flags of Lexapro overdose is a rapid and irregular heartbeat (tachycardia).4 If an overdose is suspected, please immediately call 911 or visit an emergency room.

Lexapro Withdrawal, Dependence, & Addiction

Even if you take Lexapro exactly as directed, you will likely develop a physiological dependence on it. This doesn’t mean that you’re addicted to Lexapro—rather, it means that your body has adapted to the presence of it. Because of this dependence and potential for Lexapro withdrawal symptoms, you should never just quit taking Lexapro “cold turkey.” You should always speak to your doctor before quitting so they can gradually taper it off of you so your body can slowly adjust to the decreasing doses.

However, if you misuse Lexapro, you may develop a more severe dependence, resulting in severe withdrawal symptoms or antidepressant discontinuation syndrome when you quit. Lexapro withdrawal symptoms may include:4,8,9,10

  • Confusion
  • Dizziness
  • Chills
  • Trouble sleeping
  • Anxiety or panic
  • Agitation
  • Irritable mood
  • Mood swings
  • Fatigue
  • Inability to experience pleasure
  • Sweating
  • Nightmares
  • Vomiting
  • Diarrhea
  • Tension
  • Sensations similar to electric shock

Signs of Lexapro Addiction

Chronic misuse of this SSRI can lead to Lexapro addiction, a condition characterized by compulsive Lexapro use regardless of the harmful effects it has on your life. Signs of Lexapro addiction may include:7

  • Taking larger doses of Lexapro than necessary
  • Faking symptoms of depression or anxiety to get Lexapro from a doctor
  • Seeing multiple doctors to get Lexapro prescriptions
  • Pretending to lose prescriptions to get early refills
  • Needing more Lexapro pills to experience the same effects they used to provide
  • Isolating yourself from friends and family
  • Hiding Lexapro use from loved ones
  • Experiencing a lack of interest in hobbies and activities you used to enjoy
  • Experiencing cravings for Lexapro
  • Mixing Lexapro with other substances
  • Wanting to control Lexapro use but failing to do so
  • Continuing to misuse Lexapro despite failure to fulfill obligations at home, school, or work
  • Continuing to misuse Lexapro despite experiencing interpersonal or social problems due to use
  • Continuing to misuse Lexapro despite knowing that it is worsening or causing physical or mental health issues

Only a qualified professional can provide you with a diagnosis and offer the treatment that you need. Call 800-926-9037 (Info iconWho Answers?) to speak with a treatment specialist who can discuss options for substance use recovery.

Resources

  1. U.S. National Library of Medicine (2020). Escitalopram.
  2. Santarsieri, D., & Schwartz, T. (2015). Antidepressant efficacy and side-effect burden: A quick guide for clinicians. Drugs in Context, (4).
  3. Wong J., Motulsky, A., Abrahamowicz, M., McGill, J., Eguale, T., Buckeridge, D. L., & Tamblyn, R. (2017). Off-label indications for antidepressants in primary care: Descriptive study of prescriptions from an indication-based electronic prescribing system. The British Medical Journal,
  4. Evans, E. & Sullivan, M. (2014). Abuse and misuse of antidepressants. Substance Abuse Rehabilitation, 5:107–120.
  5. Khan, F., & Bernadt, M. (2011). Intense suicidal thoughts and self-harm following escitalopram treatment. Indian Journal of Psychological Medicine, 33(1), 74–76.
  6. Volpi-Abadie, J., Kaye, A., & Kaye, A. (2013). Serotonin syndrome. The Ochsner Journal, 13(4), 533–540.
  7. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders(5th ed.).
  8. Basile, M. E. (2019). Escitalopram. In B. Narins (Ed.), The Gale Encyclopedia of Mental Health(4th ed., Vol. 2, pp. 619-623). Gale.
  9. Food and Drug Administration. (January 2017). Lexapro [medication guide]. 
  10. Jha, M. K., Rush, A. J., & Trivedi, M. H. (2018). When discontinuing SSRI antidepressants is a challenge: management tips.The American Journal of Psychiatry175(12), 1176–1184.
Pen iconAuthor
Angie Doel, MS, BA, Holistic Nutritionist Certification
Psychotherapist, Health & Wellness Writer
After graduating from the University of Pennsylvania with her degree in Counseling Psychology, Angela M. Doel worked as a psychotherapist, primarily with families and couples. Her research interests include interpersonal communication, and in 2020, she published The Couples Communication Workbook: Therapeutic Homework Assignments to Foster Supportive Relationships. Along with publishing five other