Escitalopram: what it treats, how to take it, side effects
Last updated September 3, 2026.
Escitalopram is an SSRI antidepressant that increases serotonin in the brain to help maintain mental balance. You may know it as Lexapro. It treats depression and generalized anxiety disorder, and it carries the class boxed warning about suicidal thoughts in younger patients.
What does it treat?
Escitalopram treats depression and generalized anxiety disorder (GAD) - the kind of excessive worry and tension that disrupts daily life and lasts 6 months or longer. The label supports continued treatment after symptoms respond, with periodic re-evaluation of whether it is still needed.
How do you take it?
Once a day, with or without food, at the same time each day, morning or evening. The label's dosing runs at 10 mg or 20 mg daily, with 10 mg recommended for older adults and people with liver impairment; your doctor may start low and increase after a week or more. Give it several weeks before judging it. Never stop suddenly: MedlinePlus lists withdrawal symptoms including mood changes, irritability, nausea, dizziness, burning or tingling in the hands or feet, anxiety, confusion, sweating, shaking, and insomnia, and the exit is a gradual dose reduction your doctor controls. Missed dose: take it when you remember unless the next one is close; never double up.
Side effects to know
- Common: nausea, sexual problems (decreased sex drive, difficulty with erection, delayed or absent orgasm or ejaculation), drowsiness, trouble sleeping, and increased sweating.
- Serious: the boxed warning - new or worsening depression, suicidal thoughts or actions, agitation, panic attacks, severe restlessness, especially under age 24 in the first months or after a dose increase. Also serious: hallucinations or unusual excitement; serotonin syndrome (fever, sweating, confusion, fast or irregular heartbeat, severe muscle stiffness, agitation, loss of coordination, vomiting, diarrhea); abnormal bleeding or bruising; low sodium (headache, unsteadiness, trouble thinking or remembering); seizures; allergic reactions; and angle-closure glaucoma (eye pain, vision changes, colored rings around lights).
Who should not take it?
Do not combine escitalopram with MAO inhibitors, including having stopped one within the past two weeks - linezolid and methylene blue count too. Interactions needing a doctor's input include aspirin, ibuprofen, naproxen, St. John's wort, and tryptophan. Tell your doctor about bleeding problems, seizures, glaucoma, or liver, kidney, or heart disease, and about any heavy alcohol use or substance misuse. If you are pregnant (especially in the last few months), planning pregnancy, or breastfeeding, have the risks-benefits talk before starting. Escitalopram can cause drowsiness and affect judgment and movement - no driving until you know its effects, and alcohol makes side effects worse.
When is it an emergency?
Thoughts of harming or killing yourself are the emergency - call your doctor, call or text 988 (the Suicide and Crisis Lifeline), or go to an emergency room. Serotonin syndrome, seizures, and allergic reactions with facial or throat swelling or trouble breathing need emergency care, as does sudden eye pain with vision changes. For an overdose, call Poison Control at 1-800-222-1222. Pymander's escalation routing is built and tested specifically for this class of decision; see the safety architecture working paper.
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Common questions
How long does escitalopram take to work?
Several weeks. MedlinePlus says it may take that long to feel the full benefit, and doctors typically wait at least a week before increasing the dose. Keep taking it even if you feel well - and if you feel nothing after a fair trial, that is a conversation with your prescriber, not a reason to double your dose.
Can I stop escitalopram when I feel better?
Not on your own. MedlinePlus lists the withdrawal symptoms - mood changes, irritability, agitation, nausea, dizziness, burning or tingling in the hands or feet, anxiety, confusion, headache, sweating, shaking, and sleep problems - and says your doctor will decrease your dose gradually. Feeling better is the medication working, and the exit is planned, not abrupt.
Can I drink alcohol on escitalopram?
Ask your doctor. MedlinePlus notes alcohol can make escitalopram's side effects worse, and it advises disclosing any history of heavy drinking before starting. Your prescriber knows your dose and your history - that is where the answer lives.
Is escitalopram the same as Lexapro?
Yes - Lexapro is the brand name, escitalopram the generic. Same active ingredient, same SSRI class. Generics meet the same FDA standards, which is why the label and the MedlinePlus guidance apply equally to both.
Can I take it with food?
Your choice. MedlinePlus says escitalopram is taken once a day with or without food - consistency of timing matters more than the meal.
Why did my doctor tell me to avoid ibuprofen while on it?
Because of bleeding risk. MedlinePlus flags aspirin, ibuprofen, and naproxen as interacting with escitalopram, and lists abnormal bleeding or bruising among its serious side effects. Do not start any of them while taking it without checking with your healthcare provider - your doctor can suggest alternatives.