Lexapro (escitalopram) is a prescription antidepressant taken primarily for two conditions: major depressive disorder and generalized anxiety disorder. It belongs to a class of medications called SSRIs, which work by increasing serotonin levels in the brain. It’s one of the most commonly prescribed antidepressants in the United States, available as a once-daily tablet or liquid.
FDA-Approved Uses
Lexapro is officially approved to treat two conditions. The first is major depressive disorder (MDD) in both adults and adolescents aged 12 and older. The second is generalized anxiety disorder (GAD) in adults. These are the uses backed by the strongest clinical trial evidence and reviewed by the FDA.
For depression, the standard starting dose is 10 mg once daily for both adults and adolescents. If needed, the dose can be increased to 20 mg, though clinical trials found that 20 mg didn’t consistently outperform 10 mg in adults. For adolescents, any increase to 20 mg should happen after at least three weeks on the lower dose, while adults may increase after one week. For generalized anxiety disorder, the same 10 mg starting dose applies, with the option to increase to 20 mg after a minimum of one week.
Off-Label Uses
Doctors also prescribe Lexapro for conditions beyond its two FDA-approved indications. These “off-label” uses are legal and common in medicine, though they rely on less formal evidence. Lexapro is sometimes prescribed for obsessive-compulsive disorder (OCD), panic attacks, and social anxiety disorder. The NHS lists OCD and panic disorder among the conditions escitalopram is used for in clinical practice. Off-label prescribing is especially common when a patient hasn’t responded well to other medications or when a closely related condition overlaps with depression or anxiety.
How Lexapro Works
Lexapro is a selective serotonin reuptake inhibitor, or SSRI. In simple terms, your brain naturally recycles serotonin after it’s released between nerve cells. Lexapro blocks that recycling process, leaving more serotonin available to keep working. Serotonin plays a role in mood regulation, sleep, appetite, and emotional stability, so boosting its availability can relieve symptoms of depression and anxiety over time.
What makes Lexapro slightly different from older SSRIs is its chemical precision. Escitalopram is a refined version of an older drug called citalopram. It contains only the active mirror-image molecule responsible for the antidepressant effect, while citalopram contains both the active and inactive forms. A meta-analysis of nine trials covering over 2,000 patients found that escitalopram was significantly more effective than citalopram, with an overall remission rate advantage of about 17.6 percentage points. The difference was even more pronounced in people with severe depression. Escitalopram has also shown advantages over paroxetine in head-to-head trials.
How Long It Takes to Work
Lexapro increases serotonin levels within hours of taking it, but you won’t feel the full therapeutic benefit for weeks. The earliest signs that the medication is working tend to be physical: better sleep, more energy, or improved appetite. Some people notice these changes within one to two weeks.
The core emotional symptoms, like persistent sadness, loss of interest in things you used to enjoy, or a constant sense of dread, typically take longer to improve. Full relief from these symptoms can take six to eight weeks. This lag is one of the most frustrating parts of starting an antidepressant, but it’s normal. The brain needs time to adapt to the new serotonin levels and rewire the signaling patterns that contribute to depression and anxiety.
Common Side Effects
Most side effects from Lexapro are mild and tend to appear in the first week or two as your body adjusts. The most frequently reported ones include nausea, headache, trouble sleeping or excessive drowsiness, dry mouth, and increased sweating. Sexual side effects, including reduced desire and difficulty reaching orgasm, are also common with SSRIs and can persist for as long as you take the medication.
Many of these side effects ease within a few weeks. Nausea, for instance, often resolves once your digestive system adjusts to the medication. Taking Lexapro with food or at a consistent time each day can help minimize early discomfort.
Important Safety Considerations
All antidepressants, including Lexapro, carry an FDA boxed warning about an increased risk of suicidal thoughts and behavior in children, adolescents, and young adults under 25. This risk is highest in the first few weeks of treatment or when doses are changed. It doesn’t mean the medication causes suicidal behavior in most people, but close monitoring during early treatment is important, especially for younger patients.
Lexapro should not be taken with another class of antidepressants called MAO inhibitors, as the combination can cause a dangerous buildup of serotonin known as serotonin syndrome. Symptoms include agitation, rapid heartbeat, high body temperature, and muscle rigidity. This is rare but serious.
Stopping Lexapro Safely
Lexapro should not be stopped abruptly. Doing so can cause withdrawal symptoms such as dizziness, irritability, nausea, brain zaps (brief electric-shock sensations), and flu-like feelings. The good news is that escitalopram is classified as having a low potential risk for withdrawal compared to some other antidepressants.
The standard approach is tapering: gradually reducing your dose over several weeks or months. A common starting strategy is to cut the dose by about 25% to 50% every two to four weeks. If you’ve been taking Lexapro for many months or years, a slower taper is usually better, sometimes reducing by as little as 5% to 10% at a time. If withdrawal symptoms appear at any step, the recommendation is to go back to the last comfortable dose and wait before trying again. Some people need to taper down to a very small fraction of their original dose before stopping entirely.