Mirror Health
Medication Guide
Escitalopram (Lexapro)
SSRI · Selective serotonin reuptake inhibitorA once-daily medication used to support mood and anxiety. Here's what to expect while taking it.
How it's taken
Most adults start at 10 mg once daily. Depending on response, a prescriber may increase to a maximum of 20 mg once daily, usually after at least a week. Some people begin at 5 mg. Tablets come in 5, 10, and 20 mg.
Take it once a day at about the same time, with or without food. Morning or evening both work — if it makes you sleepy, try evening; if it disrupts sleep, try morning. It's a daily medicine, not something to take only when symptoms flare.
Older adults and people with significant liver problems are usually kept at a 10 mg daily maximum.
How long until it works
Sleep, appetite, and energy often begin to improve within the first 1–2 weeks. The fuller benefit for mood and anxiety usually takes 4–6 weeks, sometimes up to 8.
It's normal not to feel different at first. Keep taking it as prescribed, and check in with your prescriber about how it's going rather than stopping on your own.
If you miss a dose
Take it as soon as you remember that same day. If it's nearly time for your next dose, skip the one you missed — don't take two to catch up.
Common side effects
Many of these ease over the first couple of weeks as your body adjusts:
- Nausea, dry mouth, or increased sweating
- Trouble sleeping, or feeling sleepy and tired
- Headache or dizziness
- Constipation, diarrhea, or reduced appetite
- Sexual side effects — lower interest, delayed orgasm, or difficulty with ejaculation
Let your prescriber know if any of these stick around or bother you — there are often ways to help.
Serious side effects
These are uncommon, but contact your prescriber promptly — or seek urgent care for severe symptoms:
- Serotonin syndrome — agitation, fast heartbeat, sweating, shivering, muscle twitching or stiffness, confusion (more likely when combined with other serotonin-affecting medicines)
- New or worsening agitation, irritability, or thoughts of self-harm (see the boxed warning below)
- Unusual bleeding or bruising — higher risk alongside aspirin, NSAIDs, or blood thinners
- Low sodium — headache, weakness, confusion, or unsteadiness, especially in older adults
- Signs of mania — racing thoughts, little need for sleep, unusually high energy
- Eye pain or sudden vision changes
- A seizure (rare)
- Allergic reaction — rash, swelling, or trouble breathing → call 911
Suicidal thoughts in young people
Antidepressants can increase the risk of suicidal thoughts and behaviors in children, teens, and young adults under 25 — most often in the first weeks of treatment or after a dose change.
Watch closely during that window for worsening mood, agitation, irritability, or thoughts of self-harm, and stay in contact with your prescriber. This warning is a reminder to monitor carefully, not a sign the medicine is unsafe for everyone. It is not prescribed for children under 7.
Stopping the medication
Don't stop suddenly. Stopping abruptly can cause discontinuation symptoms — dizziness, flu-like feelings, irritability, trouble sleeping, or brief "brain-zap" sensations. When it's time to stop, your prescriber will help you lower the dose gradually.
Interactions & cautions
- MAOIs: do not take with an MAOI, or within 14 days of stopping one.
- Tell your prescriber about all medicines and supplements — especially other serotonin-affecting ones (other antidepressants, migraine triptans, tramadol, St. John's Wort), blood thinners or NSAIDs, and the medicine pimozide.
- Alcohol isn't recommended while taking it.
- Tell your prescriber if you're pregnant, planning a pregnancy, or breastfeeding so you can weigh the options together.