Disclaimer: None of the information in this article constitutes medical advice, and is just the opinion of the writer(s) and published for informational purposes only. We recommend that patients follow their doctor’s guidance in regard to prescription medication.
Escitalopram is a prescription antidepressant medication, and is a member of a class of drugs called Selective Serotonin Reuptake Inhibitors (SSRI). The brand name version of this drug is Lexapro. We will use these two terms interchangeably throughout the article because they refer to the same active chemical compound.
In this article we’ll review published medical studies on escitalopram to determine if it’s safe and effective for treating anxiety and depression. We’ll highlight side effects of the medication and share information about a natural, over-the-counter (OTC) antidepressant that patients may wish to speak to their doctor about.
Escitalopram for Depression
Escitalopram has been studied in numerous medical trials for treating Major Depressive Disorder (MDD), as we documented in our Lexapro reviews for depression article.
A meta-study on escitalopram published in 2010 analyzed 18 individual clinical trials on the drug, and concluded that it was an “effective and generally well tolerated treatment” for depression.
Another medical review of escitalopram, published in the Current Medical Research and Opinion journal, found that the medication was superior to other antidepressants. Escitalopram was found in this study to be more effective than other SSRI medications, with an average treatment rate of 62.1% versus 58.4% for the average SSRI. Escitalopram was also more effective than Serotonin/Noradrenaline Reuptake Inhibitors (SNRIs), which is another class of antidepressant.
These results are impressive, given that in these studies escitalopram is being compared favorably to other prescription drugs approved by the Food and Drug Administration (FDA) to treat depression.
We will conclude based on a review of medical research that escitalopram is effective for treating depression, and appears to be more effective than most antidepressants.
Escitalopram for Anxiety
Escitalopram is also approved by the FDA to treat Generalized Anxiety Disorder (GAD). A meta-study of escitalopram and GAD found that the drug was effective for both short-term and long-term treatment of this condition. The studies analyzed by researchers in this review ranged between 8 to 76 weeks.
A clinical trial examined whether escitalopram could be effective for treating panic disorder, which tends to be more severe and harder to treat than GAD. 366 patients with panic disorder received either escitalopram, another prescription anxiety medication called Celexa, or placebo pills, and their symptoms of panic disorder were tracked over the course of the 10 week trial
Escitalopram was more efficacious than placebo, and increased the number of patients that experienced zero panic attacks. One significant finding is that fewer patients had to discontinue the trial on escitalopram than on placebo, which suggests that the drug causes no significant side effects in a patient population with panic disorder.
Celexa and escitalopram were similarly effective in this study. While we wouldn’t recommend that patients use escitalopram for panic disorder because it’s not approved by the FDA to treat this condition, we are hopeful that more research on the topic emerges.
We will conclude from the available research that escitalopram is effective for treating generalized anxiety, and may be effective for treating panic disorder.
How Does Escitalopram Work?
We believe it’s important for patients to understand how their medications work, so that they may notice patterns in which type of medications are most effective for them.
Escitalopram is an SSRI drug, which means that it limits re-uptake of serotonin. This neurotransmitter influences mood and sedation.
Limiting reuptake of serotonin artificially increases its levels in the brain, which can have a beneficial effect on depressed patients. Scientists are still unclear on exactly how and why SSRIs are effective, but the leading theory is that patients without mental health conditions tend to have higher circulating levels of serotonin than those with depression.
Escitalopram Side Effects
Escitalopram has an established side effect profile that patients should be aware of.
A medical review of the drug noted that the most common were: insomnia, ejaculation disorder, nausea, increased sweating, fatigue and sleepiness.
One patient out of 125 taking escitalopram developed suicidal thoughts, and 6 patients out of 544 (slightly over 1%) attempted suicide. Because depressed patients are more likely to attempt suicide than patients without depression, it’s unclear whether the drug actively caused these attempts.
The FDA does require a black box warning to be listed on escitalopram’s label, indicating that the drug may increase the risk of suicidal thinking and behavior. Black box warnings are the most severe level of warning issued by the FDA, and indicate side effects that may have life-threatening effects.
We definitely would recommend that patients speak with their doctor about the potentially increased suicide risk before taking this medication. If the patient has a personal or family history of suicidal thoughts, their doctor may recommend an antidepressant without this potential side effect.
It’s notable that in the above-linked review of escitalopram side effects, patients taking 20 milligrams (mg) of the drug were more likely (10% vs. 4%) to drop out of the trial due to adverse events than patients taking 10 mg. This suggests that it may be worthwhile for patients with moderate depression to speak with their doctor about starting on a 10 mg rather than 20 mg dose to minimize side effects.
Natural Antidepressant - Lithium
Because prescription antidepressants like escitalopram have some serious side effects to consider, patients with mild or moderate depression may benefit from speaking to their doctor about lithium supplementation as a potential first-line treatment.
Lithium is a compound that has been proven effective as an antidepressant. It’s available over-the-counter (OTC); not requiring a prescription for purchase. It can be purchased online or at drug stores or health food stores.
A medical review of lithium for mental health conditions, published in the Neuropsychopharmacology journal, found that the metal is effective for treating depression on average. The more surprising result was that lithium supplementation also improved the efficacy of prescription antidepressants when taken concurrently. Lithium also significantly reduced the rate of suicidality, which is the opposite effect of many prescription antidepressants.
The only lithium dose mentioned in the above-linked study is 150 mg/day.
Another meta-study from 2019 analyzed the results of 39 clinical trials on lithium supplementation for depression. The researchers found that lithium was effective on average, and seemed to be especially effective for those with both depression and bipolar disorder.
The doses used in the studies varied considerably, and there doesn’t seem to be a medical standard for lithium dosage in treatment of depression, like there are clear standards for pharmaceutical dosage.
We would recommend that patients work with their doctor on a safe daily dosage for this supplement if they choose to take it. We’re not suggesting that lithium is as effective as escitalopram, but we do believe it has a more favorable side effect profile which makes it a potentially beneficial candidate for patients with milder forms of depression.
Should I Take The Branded Version Of Escitalopram?
As we referenced previously, the brand name version of escitalopram is Lexapro.
Generally, we recommend that patients speak with their doctor about the generic version of drugs instead of the branded version, as generics are generally as effective but much cheaper.
However, a medical review of generic vs. brand-name drugs that we often cite in Illuminate Health articles found that Lexapro actually caused fewer psychiatric hospitalizations when compared to the generic escitalopram. This review documents how generics are as effective as branded drugs on average, but in some cases they are not.
It’s unclear what causes Lexapro to potentially be safer than escitalopram. Perhaps the branded drug manufacturer has better quality controls during manufacturing.
We would recommend that patients speak with their doctor about Lexapro instead of escitalopram in light of this data.
Escitalopram Dosage
According to StatPearls, which is one of the largest free medical databases in the U.S., the typical dosage range of escitalopram is 10 mg to 30 mg per day. The site lists the typical starting dose as 10 mg.
Doctors will often start patients on the minimum effective dose of a drug, because if this dose is effective it will reduce the risk of side effects compared with higher doses. If the patient is unresponsive at the lower dose, the doctor may slowly taper their dose up to the maximum effective dose.
Elderly patients cannot process escitalopram as well as healthy younger adults, so the dosage recommendation for geriatric patients is 10 mg.
Escitalopram Vs. Zoloft
Zoloft is another popular prescription antidepressant, so patients are often curious about which drug is more effective.
A comparative review published in 2014 analyzed data on both medications, and stated that escitalopram “is the first choice judged by combined efficacy and tolerability.” The study authors are suggesting here that escitalopram is both more effective and safer.
Another medical study examined whether escitalopram or Zoloft worked better for major depression. Escitalopram caused a 74% remission in symptoms, while Zoloft caused a 77% remission in symptoms. The side effect rate was 11% lower in patients taking escitalopram (45% vs. 56%). This led to the study authors concluding that escitalopram was the best option overall. It was only slightly less effective but caused significantly fewer side effects.
We would recommend that patients speak with their doctor about escitalopram rather than Zoloft.
Escitalopram User Reviews
Escitalopram has been reviewed over 3,000 times on Drugs.com, which is the largest website for prescription medication reviews by users. We can’t verify the accuracy or authenticity of the information on this site, but we often find the user reviews to be insightful.
Users taking escitalopram for anxiety rated the drug higher than users taking it for depression (7.4/10 vs. 7.1/10), but both ratings are better than average.
The top positive review of the medication for anxiety is written by a user named “osky” who claims that the drug improved their quality of life:
“In my darkest hours whilst waiting for the drug to kick in I would read all the positive reviews on this website and they gave me confidence that everything would be OK. Without you, I don't know what I would have done. A couple of years later and my life is on track and the future is looking rosy!”
The top negative review of escitalopram comes from a user named “Timbo323” who rated the drug 5/10 and claims it caused uncomfortable side effects:
“Hi, I’ve been on 10mg of [escitalopram] for 3+ weeks and still having side effects or anxiety attacks. Shaking hands, burning feet and mouth. Seems to get worse 2 hoiurs after I take a dose.”
Escitalopram and Alcohol
According to the FDA label for escitalopram which we linked to earlier in this article, it’s not recommended to use alcohol while taking the medication. This is common for SSRI drugs.
Alcohol use while taking escitalopram may cause negative health effects, and may also cause short-term cognitive and motor effects which make regular tasks such as driving unsafe.
Due to this contraindication, we believe it’s important for patients to be honest with their doctor about their alcohol habits. Escitalopram may not be the best choice for a patient who is unwilling or unable to refrain from alcohol intake entirely, so the doctor may be able to prescribe a different antidepressant in those cases which doesn’t have a negative interaction with alcohol.
