Lexapro (escitalopram) is an antidepressant prescribed 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, taken as a once-daily pill.
FDA-Approved Uses
Lexapro is formally approved to treat major depressive disorder (MDD) in adults and in adolescents aged 12 and older. It’s also approved for generalized anxiety disorder (GAD) in adults. These are the two conditions it has been specifically tested and cleared for by the FDA.
Major depressive disorder involves persistent low mood, loss of interest in activities, changes in sleep or appetite, difficulty concentrating, and fatigue lasting at least two weeks. Generalized anxiety disorder is characterized by excessive, hard-to-control worry about everyday things, often accompanied by muscle tension, restlessness, and trouble sleeping.
Doctors sometimes prescribe Lexapro for other anxiety-related conditions like social anxiety, panic disorder, or obsessive-compulsive disorder. These are considered off-label uses, meaning the drug hasn’t gone through the formal FDA approval process for those specific diagnoses, though there may be clinical evidence supporting its effectiveness.
How Well It Works
In clinical trials for generalized anxiety disorder, about 1 in 5 patients who took Lexapro responded to treatment who wouldn’t have responded to a placebo. That translates to a “number needed to treat” of about 5, meaning for every 5 people who take it, one will experience meaningful improvement beyond what a sugar pill would provide. That’s a solid result for a psychiatric medication.
The relapse prevention data is particularly striking. In a long-term study, 56% of patients switched to placebo relapsed, compared to only 19% of those who stayed on escitalopram. Patients on placebo had four times the risk of their symptoms returning. This is a key reason many people stay on Lexapro for months or years after their symptoms improve.
How Long It Takes to Work
Lexapro doesn’t work overnight. You may notice some early changes in sleep, energy, and appetite within the first one to two weeks. Full therapeutic effects, the kind where you consistently feel meaningfully better, typically take four to six weeks. This delay is one of the most frustrating aspects of antidepressant treatment, but it’s normal and expected.
The standard starting dose is 10 mg once daily for both depression and anxiety. If that isn’t enough after at least a week, your doctor may increase it to 20 mg, which is the maximum recommended dose. Adolescents follow the same dosing range.
Common Side Effects
The most frequently reported side effects include nausea, trouble sleeping, drowsiness, increased sweating, and sexual side effects like decreased libido or difficulty with orgasm. Many of these are most noticeable in the first week or two and tend to ease as your body adjusts.
Weight change is a common concern. Compared to sertraline (Zoloft), escitalopram users gained about 1 kg (roughly 2 pounds) more over six months. Escitalopram, along with paroxetine and duloxetine, carries a 10% to 15% higher risk of gaining at least 5% of your body weight compared to sertraline. That’s a modest but real difference, and it’s worth knowing if weight is a priority for you.
Like all SSRIs, Lexapro carries an FDA warning about increased risk of suicidal thoughts in children, adolescents, and young adults under 25, particularly in the early weeks of treatment. This doesn’t mean the medication causes suicidal behavior in most people. It means close monitoring is important during the first months, especially for younger patients.
What Stopping Looks Like
Lexapro should not be stopped abruptly. Discontinuation syndrome is a well-documented set of withdrawal-like symptoms that can occur when you quit an SSRI too quickly. Common symptoms include dizziness, flu-like feelings, nausea, trouble sleeping, vivid dreams, and irritability. Some people experience what are often called “brain zaps,” a sensation resembling a brief electric shock in the head.
People who stop rapidly, over one to seven days, are more likely to relapse within a few months than those who taper gradually over two or more weeks. A slow, step-down approach gives your brain time to adjust to lower serotonin levels. The tapering timeline varies from person to person. Some people reduce their dose over a few weeks, while others need months, particularly if they’ve been on the medication for a long time.
If discontinuation symptoms are severe, the usual approach is to return to the previous dose and then reduce more slowly. In some cases, switching temporarily to a longer-acting SSRI like fluoxetine can make the transition smoother, since it leaves the body more gradually on its own.