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What is Lexapro?

Escitalopram (marketed as Lexapro) is included in the class of drugs called selective serotonin reuptake inhibitors (SSRIs) [1]. This class of drugs is used to treat depression, anxiety, and other mood disorders. It works by boosting levels of a natural substance in the brain called serotonin.

Serotonin, known as the “happy” neurotransmitter, signals an increase in feelings of happiness or well-being. It’s released into the spaces between your brain cells (synapses) in order to transmit this “happiness” signal through your brain and central nervous system.

Although his medication may not be considered addictive, some people develop a tolerance to it and dependence on it, leading to withdrawal symptoms. The definition of addiction is the compulsion to ingest intoxicating substances, and since Lexapro does not act quickly enough on brain chemistry to induce a high, it is an unlikely target of abuse or addiction.

lexapro withdrawal
Depression can be dangerous for an unborn baby and its mother. But taking an antidepressant past week 13 of pregnancy carries risks as well. 

People who have struggled with substance abuse or polydrug abuse in the past may attempt to abuse Lexapro. The medication also has interactions with several drugs, including other prescription medications, so some may try to combine Lexapro to enhance a high from another drug.

Escitalopram may also be helpful when prescribed “off-label” for obsessive-compulsive disorder (OCD), eating disorders such as binge eating disorder or bulimia nervosa, panic disorder, posttraumatic stress disorder (PTSD), and premenstrual dysphoric disorder (PMDD). “Off-label” means that it hasn’t been approved by the Food and Drug Administration for this condition.

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How Long does it Take for Escitalopram to Work?

Escitalopram always starts working on the very first day of intake. In fact, Escitalopram begins significantly inhibiting the reuptake of serotonin within just a few hours of ingesting the first dose.

Although Escitalopram (Lexapro) substantially modifies neurotransmission on the first day of treatment, this does not automatically mean that users will derive therapeutic benefit – or even notice that the medication is “working.”

While a small percentage of Escitalopram users may respond to the medication rapidly (e.g. on the very first day of treatment, or within several days of treatment initiation), most will not notice Escitalopram working immediately.

It is most common for Escitalopram users to notice the medication working (or alleviating medical symptoms) after several weeks of daily administration – usually between weeks 4 and 8 of treatment. Moreover, some individuals may require more than 8 weeks to notice that Escitalopram has taken effect.

What are the Possible Side Effects of Escitalopram?

Most individuals do not experience severe side effects when taking Escitalopram. After a few weeks, any side effects typically go away once the body has grown accustomed to the medication.

However, there are some side effects that may include:

  • Nausea or vomiting
  • Diarrhea
  • Constipation
  • Indigestion
  • Other abdominal or digestive issues
  • Changes in sex drive
  • Irritability or mood swings
  • Rebound depression or anxiety
  • Increased sweating
  • Dizziness
  • Fatigue or exhaustion
  • Increased appetite and weight gain
  • Dry mouth
  • Runny nose, sneezing, or other flu-like symptoms

Some serious side effects could indicate a bad reaction to Escitalopram. These include:

  • Unusual excitement
  • Mania
  • Hallucinations
  • Delusions
  • Irregular heartbeat or racing heart
  • Serious muscle stiffness
  • Fever
  • Extreme confusion

It is important to contact 911 immediately when experiencing these symptoms.

Additionally, people who are younger than 24 years old are at an increased risk of developing suicidal thoughts or actions when taking SSRIs, including Escitalopram.

Individuals who have bipolar disorder that has not been diagnosed or misdiagnosed as depression are more likely to experience a serious manic episode. When a person experiences mania or hypomania, they should not take Escitalopram.

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Long-Term Use

Escitalopram has no long-term side effects except for possible dependence and tolerance, which are not associated with addiction in this instance. A physician will work with their patient to appropriately adjust their dose of Escitalopram to help with dependence and tolerance over time and, at some point, may decide to switch their patient to a different antidepressant. If an individual has an undiagnosed pre-existing condition, like liver disease, seizure disorder, kidney problems, or a thyroid problem, Escitalopram may make these conditions worse.

Lexapro and Serotonin Syndrome

“Serotonin syndrome” happens when serotonin levels in the brain become too high. Other medications which affect serotonin levels can increase the risk. These medications may include cough remedies, herbal supplements, and migraine treatments.

Symptoms of serotonin syndrome should be reported to a doctor immediately and may include:

  • Sudden or unexpected high fever
  • Increased heart rate, irregular heartbeat
  • Loss of balance, lack of coordination
  • Confusion, hallucinations
  • Seizures

Sexual Side Effects

Lexapro can also cause sexual side effects, such as delayed ejaculation or difficulty coming to orgasm. Sexual issues often don’t resolve as long as you’re taking the drug.

Weight Gain

Over time, Lexapro can contribute to weight gain. This is because depression often causes decreased appetite, and taking an antidepressant can help you eat more. Some research shows the drug can lead to weight loss in some people, too.

Drug Interactions with Lexapro

It can be dangerous to mix Lexapro with other medications and supplements. Drug interactions can occur with:

  • Other antidepressants: SSRIs like Celexa (citalopram), Prozac (fluoxetine), and Zoloft (sertraline) increase the risk of serotonin syndrome if you take them with Lexapro. So do monoamine oxidase inhibitors (MAOIs) like Zyvox (linezolid).
  • Pimozide: Combining Lexapro with the antipsychotic drug pimozide (Orap) can cause severe heart problems.
  • Blood thinners: Prescription drugs that decrease blood clotting, like Coumadin (warfarin), raise the risk of bleeding when combined with Lexapro.
  • Non-steroidal anti-inflammatory drugs (NSAIDs): Over-the-counter medications like ibuprofen (Motrin, Advil) and naproxen (Aleve) also increase bleeding risk by decreasing blood clotting. 
  • Some supplements: Check with a healthcare professional for specifics, but St. John’s Wort is one supplement that raises the chance of side effects and can cause serotonin syndrome.

What Causes Lexapro Withdrawal?

Withdrawal is a set of symptoms that may occur when the amount of a particular medication or drug in a person’s body decreases significantly.

Some patients who take Lexapro (escitalopram) and feel better may assume that they no longer need the medicine, so they stop taking it. 

Stopping Lexapro suddenly is unwise because the medication has an important relationship with serotonin, the neurotransmitter found in blood platelets and the central nervous system linked to depression. As a result, when medications like Lexapro that affect serotonin levels in the brain are suddenly stopped, you may experience very serious emotional and physical symptoms.

Once a person stops taking Lexapro, the body needs time to adjust. The amount of serotonin may decrease suddenly and will need time to replenish. During this time, a person may experience withdrawal symptoms.

Factors Affecting Lexapro Withdrawal

There are several factors that will affect your Lexapro withdrawal:

  • How much Lexapro you take
  • The frequency with which you take it
  • The amount of time you have been on it
  • Whether or not you go cold turkey
  • Your body make up, including your brain

These factors can affect the length and severity of your withdrawal. For instance, the longer you take Lexapro, the more severe your withdrawal is likely to be. These factors also help determine how a doctor treats your withdrawal.

Lexapro Withdrawal
If you’re considering an antidepressant for someone under 24, be sure to discuss this issue with your doctor and explore your options.

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Lexapro Withdrawal Symptoms

As previously mentioned, Lexapro withdrawal symptoms start after abrupt cessation following prolonged use. Furthermore, it’s worth noting that this phenomenon is not unique to Lexapro, and it can occur with even greater frequency in those SSRIs that have shorter durations of action than Lexapro 

The symptoms and signs can occur within days or weeks from stopping Lexapro and are dependent on the duration of usage, the half-life of the medication, and the patient’s individual physiology. There can be over 53 different Lexapro withdrawal symptoms and signs which can occur within 1 to 7 days of stopping or reducing SSRI use as reported by one study [3] which attempted to develop diagnostic criteria for SSRI discontinuation syndrome.

The Most Frequently Encountered Lexapro Withdrawal Symptoms Include:

  • Gastrointestinal Problems: Nausea, emesis, anorexia, cramps, and diarrhea
  • Hyperarousal: jerkiness, anxiety, irritability, mania, agitation, aggression
  • Vasomotor Instability: Hyperhydrosis, Flushing, Difficulty tolerating heat
  • Flu-like Symptoms: malaise, fatigue, aching, headache
  • Paresthesias: sensations of “burning” “tingling” “electric brain zaps”
  • Sleep Disturbances: Insomnia, Hypersomnia, Vivid dreams, Nightmares
  • Imbalance: Dizziness, Pre-syncope, uneven gait

Furthermore, with continued disuse of SSRI medications, Lexapro withdrawal symptoms, such as anxiety and depression may arise which may be related to the relapse of the patient’s Major Depression or Generalized Anxiety for which they were receiving antidepressant treatment with SSRIs in the first place.

Tips for Coping with Lexapro Withdrawal Symptoms

A person should never try to quit Lexapro without discussing this decision with their doctor and developing an action plan.

In most cases, a doctor will recommend slowly reducing the dosage and possibly switching to an alternative SSRI medication to aid the tapering process.

Some general tips for coping with Lexapro withdrawal symptoms include:

  • Eating a healthful and nutritious diet
  • Exercising regularly
  • Taking all other medications according to the prescription
  • Completing the tapering process
  • Tracking changes in mood on a calendar or in a notebook
  • Telling a doctor about any withdrawal symptoms
  • Seeking support from friends, family, or community groups

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What is the Timeline for Lexapro Withdrawal?

The length of Lexapro withdrawal symptoms depends on several factors, including how long a person has taken the medication as well as the dosage that they are taking. Lexapro withdrawal symptoms also tend to last longer if a person quits cold turkey rather than gradually tapering off of the medication.

Given these many considerations, there is not an exact timeline to determine how long a person will experience Lexapro withdrawal symptoms. A large number of people, however, notice that the most severe discontinuation symptoms tend to increase after 90 days or three months. There are people, however, who report taking months or even over a year to fully recover.

Know the Warning Signs of Lexapro Withdrawal

When you stop or reduce your dose of Lexapro, there is a risk that you may begin to feel suicidal. Large-scale research studies have found a clear association between the discontinuation of antidepressants and suicide attempts.

It is important to keep this in mind during your withdrawal experience. If you begin noticing unusually strong symptoms of depression it is imperative that you seek help immediately. 

If you or someone you love shows any of the following signs or symptoms after stopping Lexapro, get help:

  • Becoming preoccupied with death, dying, or violence
  • Engaging in risky or self-destructive activities, such as driving drunk
  • Feeling hopeless or trapped
  • Gathering the means to commit suicide, such as bullets or pills
  • Getting affairs in order or giving away belongings
  • Having intense mood swings
  • Planning how you would commit suicide if you were going to do it
  • Saying goodbye to people as if it were the last time 
  • Talking or thinking about suicide more than normal, for example, “I wish I were dead”

There is a strong link between mental health and substance abuse. Individuals who struggle with mood disorders like depression and anxiety are more susceptible to developing an addiction to drugs or alcohol, often to self-medicate symptoms of their underlying mental health condition. These co-occurring disorders can make each other worse without proper treatment.

Lexapro Withdrawal
If you or someone you know has been affected by escitalopram misuse, there are resources to help you recover.

Many rehabilitation programs keep up with the scientific understanding of co-occurring disorders and offer dual-diagnosis treatment for mood disorders alongside therapy for addiction. Lexapro withdrawal may be part of addiction treatment to help a mood disorder. 

Treatment plans vary for each individual. For occasional substance misuse, occasional counseling may be enough to help a person recover. For more serious cases, time at a rehabilitation facility may be the best option. The only way to truly determine the correct treatment plan for each person is to see a qualified treatment professional.

If someone is abusing Lexapro because of its intense and often dangerous Lexapro withdrawal symptoms, that person ought to consider inpatient Lexapro detox. We Level Up NJ addiction specialists are standing by to help.

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Sources:

[1] FDA – https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/escitalopram-marketed-lexapro-information

[2] NIH – https://medlineplus.gov/druginfo/meds/a603005.html

[3] NCBI – https://pubmed.ncbi.nlm.nih.gov/10863885/