Disclaimer: None of the information in this article constitutes medical advice. All statements are merely the opinion of the writer(s). We recommend that patients follow their doctor’s guidance in regard to prescription medication.
Escitalopram, also called escitalopram oxalate, 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.
Is escitalopram proven to be effective for depression? What about anxiety? Does it cause side effects? And is the branded version more effective?
In this article we'll answer all of these questions and more as we summarize clinical research on escitalopram to determine if it's safe and effective for treating anxiety and depression, document its side effects and share a real, unsponsored user review of the drug.
Is Escitalopram Effective for Depression?
Escitalopram has been studied in numerous medical trials for its ability to treat Major Depressive Disorder (MDD), as we documented in our Lexapro reviews for depression article.
A meta-study on escitalopram published in 2010 analyzed results from 18 clinical trials, 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.
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.
Is Escitalopram Effective 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 worked significantly better than placebo pills, 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.
We will conclude from the available research that escitalopram is effective for treating generalized anxiety, and may be effective for treating panic disorder.
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 side effects 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 was the cause of 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 side effects 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.
Real, Unsponsored User Review of Escitalopram
One of the most popular YouTube reviews of escitalopram comes from a creator named Hannah Cheung. She shares her experience after taking escitalopram for a month, and explains the benefits as well as the side effects.
The video has well over 100,000 views at the time of updating this article, and is unsponsored:
Is the Branded Version Safer?
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 comparing generic and brand-name drugs found that Lexapro was associated with fewer psychiatric hospitalizations when compared to the generic escitalopram. The above-linked review documents how generics are as effective as branded drugs on average, but in some cases they are not.
It’s unclear what causes the association of fewer hospitalizations with Lexapro compared to escitalopram. Discussion is recommended with your healthcare provider if the branded Lexapro may be more appropriate for you.
Escitalopram and Alcohol Interaction
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 intake. Escitalopram may not be the best choice for a patient who is unwilling or unable to refrain from alcohol intake entirely, and in those cases their doctor may be able to prescribe a different antidepressant which doesn’t have a negative interaction with alcohol.
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.
Our Mental Wellness Platform Recommendation
We recommend a platform called Brightside to patients dealing with mental health issues. It's an online therapy and medication platform that connects patients with licensed doctors and therapists from the comfort of their home.
A medical review published in the Clinical Psychology & Psychotherapy journal found that online therapy was equally effective to in-person therapy for treating depression, anxiety and PTSD. Therapy may be a good first option for patients who want to avoid the side effects of medication.
Brightside also can connect patients with licensed psychiatrists that can prescribe medication. Some patients choose only therapy, some choose only medication, and some choose both. The brand reports that 86% of members feel significantly better within 12 weeks of treatment.
Patients with and without health insurance can use Brightside. For many patients with health insurance, treatment is entirely covered by insurance.
The cost for medication without health insurance is capped at $95/month and the cost for therapy without health insurance is capped at $299/month.
Interested patients can check out Brightside at this link to the brand's website.
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 increase 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. Citalopram
Citalopram is another commonly-prescribed antidepressant, so patients are often curious about which drug is more effective. The two drugs have been directly compared in clinical research studies.
A 2014 medical review examined the effectiveness of citalopram versus other leading antidepressants. Citalopram was shown to be "significantly less effective than escitalopram."
Since the drugs have a similar safety profile (both have a black box warning on their label), we would recommend that patients speak with their doctor about escitalopram rather than citalopram since it seems to be more effective.
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.
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 escitalopram 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 for anxiety 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.”
