When a series of difficult family and financial issues simultaneously came to a head, 43-year-old Suzanne* began to feel herself spiraling down into a dark and seemingly inescapable place in her mind that she suspected was true depression. A visit to a psychiatrist confirmed her suspicions and together she and the doctor agreed that antidepressant medication was necessary at that time. The psychiatrist prescribed Lexapro, and within just a couple of weeks of taking the first pill, Suzanne began to feel more hopeful and more like her old self again. Throughout the 18 months she took Lexapro, her mental outlook improved and remained healthy so she was able to work with a psychotherapist and learn to cope with what had felt like overwhelming personal circumstances. Her life improved.

Not so for 16-year old Coralie*, who struggled with severe anxiety and panic attacks in high school and was also prescribed Lexapro. Within two weeks of starting medication, instead of feeling better, her mood became darker and darker.  Soon Coralie began to have suicidal thoughts. She never acted on those thoughts, but after they become powerful enough to land her in the emergency room, she stopped taking Lexapro, and her parents sought new treatment that involved more intensive psychotherapy.

“Most people feel better with antidepressants but, for some—especially those under the age of 25 and those with bipolar depression—these drugs can make mental disturbances feel even worse,” says Psycom Editorial Board Advisor Chris Aiken, MD. Dr. Aiken is also the director of the Mood Treatment Centers in western North Carolina and editor-in-chief of The Carlat Psychiatry Report.  “Keep in close contact with your doctor if you’re not feeling better or you actually feel worse, because it can be difficult for you to tell if such a response is the sign of a serious reaction or simply a side effect that is harmless and will go away with time,” he says.

How Does Lexapro Work?

Neither depression nor the activity of antidepressant medications, are fully understood. Depression has long been associated with lower-than-normal levels of a neurotransmitter, or chemical messenger in the brain, known as serotonin. Normally, serotonin helps transport messages from one neuron (brain cell) to another, then moves on and is recycled, so that messaging can be continued. Like other SSRI antidepressants, Lexapro slows down this process, which increases the amount of serotonin available to brain cells at any given time and correcting what is thought to be a chemical imbalance. Newer research suggests that this increase of serotonin, over time, alters other brain systems as well and that those alterations are actually responsible for improvements in mood.

“Lexapro raises the levels of neuroprotective compounds in the brain,” Dr. Aiken adds. “These compounds help cells located in the mood center of the brain to grow and strengthen, resulting in improved connections and communication between brain cells.”

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Depression is also viewed as an inflammatory condition, and some research suggests that SSRIs work because they have anti-inflammatory properties. However, other research suggests that some SSRIs are not effective in people whose blood contains markers or indicators of inflammation. 1,2  These types of conflicting results help medical experts understand why and how some types of antidepressant medications may work for some people but not for others.

For what specific conditions is Lexapro prescribed?

Lexapro is classified as an antidepressant commonly used to treat major depressive disorders and generalized anxiety disorder. At their discretion, physicians may prescribe Lexapro for other conditions, including panic disorder, social phobia, obsessive-compulsive disorder, bulimia, and post-traumatic stress disorder.

What is a typical dose of Lexapro?

The standard initial dose of Lexapro is usually 10 mg, once daily, in the morning or evening, with or without food. If Lexapro makes you feel drowsy, it is a good idea to take it in the evening. In some cases, doctors will have a patient graduate to a higher dose. It can take three to six weeks to start feeling the effects of Lexapro, although some people respond sooner.

If you forget to take Lexapro, take your missed dose as soon as you remember. But if it’s almost time for your next dose, skip the missed dose and get back on schedule. Don’t take a double dose and don’t take more than your prescribed amount of Lexapro in any 24-hour period of time.

Can anyone take Lexapro?

Lexapro may be prescribed for adults and some adolescents, however, SSRIs are not recommended for use in all young people, due to an increased risk of suicidal thoughts and behavior in some children and young adults. The risk is especially high in those who have previously experienced suicidal thought or behaviors. Young people, their families, and caregivers should be aware of this risk and discuss any concerns with the prescribing physician, who can best determine if the benefits of taking Lexapro outweigh the risks.3

Before starting Lexapro treatment, be sure your doctor knows about any other physical or mental health conditions you have, as well as any prescription or over-the-counter medications, supplements, or herbal products you use to treat any medical or psychological condition, including other antidepressant treatments.

“Even a ‘natural’ product like St. John’s Wort can cause serious problems when taken with an SSRI,” warns Dr. Aiken. “The combination can cause a rare but serious condition known as Serotonin Syndrome, with side effects like muscle jerks, racing heart, confusion, mood swings,  gastrointestinal distress and other symptoms that result from too much serotonin in the brain.”

It is also important to tell your doctor if you have experienced allergic reactions to drugs similar to Lexapro or to any other type of drug or substance in the past. This information will help your doctor determine if it is safe for you to take Lexapro. Be aware that dangerous and potentially life-threatening reactions can occur with the use of Lexapro, especially when combined with other drugs.

Genetic testing may help determine whether or not Lexapro is the right medication for you, though the results are not always 100% accurate and the tests are not always covered by health insurance plans because evidence-based recommendations and testing standards have yet to be established. 4 Medical testing for markers of inflammation, also not yet a common practice in psychiatry, might also help narrow down your best choices for antidepressant medication. Speak to your health care providers if you are interested in pursuing these types of tests.

Are there side effects associated with taking Lexapro?

Anyone taking Lexapro or another SSRI should be closely supervised by an MD and monitored for side effects. The doctor should be notified if mood does not improve after a specified time or appears to worsen at any time. Other side effects that should be reported immediately to the prescribing doctor include:

  • Nervousness
  • Grouchiness
  • Restlessness
  • Feelings of panic
  • Hyperactivity
  • Paranoias
  • Hallucinations
  • Confusion
  • Any changes in mood or behavior
  • Increased heartbeat
  • Muscle stiffness
  • Fever
  • Nausea, diarrhea or vomiting
  • Changes in blood pressure
  • Loss of physical coordination

“SSRIs can also have blood-thinning effects,” Dr. Aiken points out, “so you may notice an increase in menstrual flow or other types of bleeding, and you may have to stop taking them if you are having surgery.”

Is it OK to suddenly stop taking Lexapro?

Always check first with your prescribing physician before you stop taking Lexapro, or change your dose. It is important to gradually taper off medications like Lexapro, and to watch for withdrawal symptoms while decreasing your dose. These symptoms—which may not be dangerous but can be very unpleasant—include dizziness, anxiety, insomnia, emotional instability, and sensations of electrical shock (“brain zaps”). If withdrawal symptoms are severe, your doctor may need to increase your reduced dose slightly and then prescribe a more gradual reduction.

Medically reviewed by Chris Aiken, MD

*Names changed to protect the privacy of the real patients who shared their stories with Psycom


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Last Updated: Jun 12, 2019