Escitalopram

What is escitalopram?

Escitalopram is used to treat depression, panic disorders, anxiety (social anxiety and generalised anxiety) and obsessive compulsive disorder. It is one of a group of medicines known as selective serotonin reuptake inhibitors (SSRIs). It is believed that SSRIs work by increasing the activity of certain chemicals in our brains called neurotransmitters, which pass signals from one brain cell to another. Although we don’t know for certain, the neurotransmitters that are most likely to be involved in depression are thought to be serotonin and noradrenaline. Selective serotonin reuptake inhibitors (SSRIs) are the most frequently prescribed antidepressants. SSRIs are called selective because they only affect serotonin. In New Zealand, escitalopram is available as tablets. Read more about antidepressants and SSRIs. 

Dose

• The usual dose of escitalopram is 10 milligrams once a day.
• Depending on your response, and if you need to, your doctor may increase your dose to 20 milligrams once a day.
• Always take your escitalopram exactly as your doctor has told you. The pharmacy label on your medicine will tell you how much escitalopram to take, how often to take it and any special instructions. 

How to take escitalopram

• Timing: Take escitalopram once a day, at the same time each day, either in the morning OR in the evening. You can take it at a time to suits you, but try to take your dose at the same time of day, each day. You can take escitalopram with or without food but if you think it is upsetting your stomach, try taking it with food.
• Missed dose: If you forget to take your tablet, take it as soon as you remember. But, if it is nearly time for your next tablet, just take the next tablet at the right time. Do not take double the amount of tablets.
• Keep taking escitalopram every day. It may take 4 to 6 weeks before you notice the full benefits of escitalopram. If you think escitalopram is not working for you, do not stop taking it suddenly; speak to your doctor or nurse before stopping. It is usually best to stop taking escitalopram very slowly to avoid side effects.

Read more about what to expect when starting SSRIs – see SSRIs and frequently asked questions (FAQs) about SSRIs.

Precautions – before starting escitalopram

• Do you have any heart problems such as irregular heartbeat?
• Have you had problems with mania or psychosis?
• Do you have problems with your kidneys or liver?
• Do you have epilepsy?
• Do you have diabetes?
• Are you pregnant or breastfeeding?
• Do you have a bleeding disorder or stomach ulcer?
• Are you taking any other medicines, including medicines you can buy without a prescription, such as herbal and complementary medicines or pain relief medicines?

If any of these apply, it’s important that you tell your doctor or pharmacist before you start escitalopram. Sometimes a medicine isn’t suitable for a person with certain conditions, or it can only be used with extra care.

Precautions – while taking escitalopram

• Alcohol: avoid alcohol while you are taking escitalopram, especially when you first start treatment. Drinking alcohol while taking SSRIs can cause drowsiness and affect concentration, putting you at risk of falls and other accidents. It can also cause agitation, aggression and forgetfulness. If you do drink alcohol, drink only small amounts and see how you feel. Do not stop taking your medication.
• Diabetes: if you have diabetes, you may need to check your blood glucose more often because escitalopram can affect the levels of glucose in your blood.

Possible side effects

Like all medicines, escitalopram can cause side effects, although not everyone gets them. Often side effects improve as your body gets used to the new medicine.

Suicidal behaviour

The use of antidepressants has been linked with an increase in suicidal thoughts and behaviour. Children, teenagers, young adults and people with a history of suicidal behaviour are particularly at risk. This is most likely during the first few weeks of starting an antidepressant or if the dose is changed. It is important to look for signs of suicidal behaviour such as agitation or aggression and ask about suicidal thoughts, self-harm, worsening of low mood, If you notice any of these signs, contact your doctor immediately.
It is okay and important to ask about suicidal thoughts and this will not increase risk. Note: escitalopram is not recommended for people under 18 years of age.  

If you need urgent help or are concerned, phone:

• Lifeline 0800 543 354 (available 24/7), or
• Healthline 0800 611 116, who can give you the phone number for your local mental health crisis line. 

Risk of bleeding

SSRIs can increase your risk of bleeding especially if taken with NSAIDs (non-steroidal anti-inflammatory drugs) such as diclofenac and ibuprofen. Check with your doctor or pharmacist before you take pain relief.

Sexual side effects

SSRIs in both men and women can cause reduced sexual drive, lack of libido and problems keeping an erection and reduce the intensity of orgasm. It’s important to talk to your healthcare provider if you get these effects, as they can be difficult to deal with and may not go away. Your healthcare provider may be able to suggest treatment or may reduce the dose of the SSRI or change to a different one. Read more about medicines and sexual problems.

Other side effects

Interactions

Escitalopram interacts with a number of medications (including pain relief medicines) and herbal supplements (such as St.John's Wort) so check with your doctor or pharmacist before starting escitalopram or before starting any new medicines.

Learn more

The following links provide more information on escitalopram:

Escitalopram (Māori) New Zealand Formulary Patient Information
Escitalopram (Air Flow); Lexapro; Loxalate Medsafe Consumer Information Sheets

References

1. Escitalopram New Zealand Formulary
2. Selective serotonin re-uptake inhibitors New Zealand Formulary
3. The role of medicines in the management of depression in primary care BPAC, 2017