LEXAPRO FAQs: Starting LEXAPRO / Dosage Issues

Covers uses of Lexapro, difference between Lexapro and other SSRIs, starting dose of Lexapro and related dosage issues.

Below are the answers to frequently asked questions about the SSRI antidepressant LEXAPRO (escitalopram oxalate). The answers are provided by HealthyPlace.com Medical Director, Harry Croft, MD, a board-certified psychiatrist.

As you are reading these answers, please remember these are "general answers" and not meant to apply to your specific situation or condition. Keep in mind that editorial content is never a substitute for the advice of a health care professional regarding your personal situation.

• Lexapro Uses and Dosage Issues
• Emotional and Physical Effects of Lexapro Missed Dose, Switching to Lexapro
• Lexapro Treatment Effectiveness
• Side Effects of Lexapro
• Drinking Alcohol and Overdose Issues
• For Women Taking Lexapro

Q: What are the uses for which LEXAPRO is being prescribed?

A: LEXAPRO has been approved by the FDA in the U.S. for the treatment of depression and generalized anxiety disorder (GAD) in adults.

Q: What is the difference between LEXAPRO and other SSRIs and other antidepressants? How does one determine if LEXAPRO or another antidepressant would be best for them?

A: LEXAPRO is very effective in the treatment of depression. Physicians generally choose an antidepressant for a particular patient based upon factors such as side effects for that particular patient, costs, and positive mindset.

In my experience, LEXAPRO has a more favorable side-effect profile, especially regarding sedation and weight gain, than the other SSRIs. However, some patients respond better to one SSRI than another and, as of now, we have no way of knowing in advance which SSRI will work best in a particular patient.

The other advantage of LEXAPRO is "ease of use," which means that most patients seem to respond to the starting dose of 10 mg so that no dose change is necessary in these patients. This is beneficial for most patients because the starting dose is the dose that works over time.

Q: What dose of LEXAPRO should a patient start with and how do you know if the dosage should be increased or decreased? When the dosage is increased or decreased, what does that do to the body and what does it feel like? What are the minimum and maximum dosages?

A: Most patients are started at 10 mg/day. Some patients might be started at 5 mg (especially those with severe anxiety disorder, or who are old or ill from other medical conditions), but most start at one 10 mg tablet. The medication is taken once a day, most commonly in the morning, but some prefer to take it in the evening or at noontime.

For all patients, 10 mg/day is the recommended starting dose of LEXAPRO. 10 mg/day is also the maintenance dose for many patients. If the dose is increased to 20 mg/day, this should occur after a minimum of 1 week. LEXAPRO can be taken morning or evening once daily, with or without food.

Your doctor may suggest a decrease in dosage if you experience side effects that do not go away after approximately 2 weeks. (Most side effects, like nausea, indigestion, diarrhea, headache, slight increase in anxiety, do go away within 2 weeks).

Once the side effects disappear, they usually do not return. However, if your physician recommends increasing your dose, the side effect may return for a brief period of time (usually no more than a day or two).

Below are the answers to frequently asked questions about the SSRI antidepressant LEXAPRO (escitalopram oxalate). The answers are provided by HealthyPlace.com Medical Director, Harry Croft, MD, a board-certified psychiatrist.

As you are reading these answers, please remember these are "general answers" and not meant to apply to your specific situation or condition. Keep in mind that editorial content is never a substitute for the advice of a health care professional.

• Lexapro Uses and Dosage Issues
• Emotional and Physical Effects of Lexapro,
  Missed Dose, Switching to Lexapro
• Lexapro Treatment Effectiveness
• Side Effects of Lexapro
• Drinking Alcohol and Overdose Issues
• For Women Taking Lexapro

Q: When you first start LEXAPRO, what should that feel like—physically and emotionally?

A: When first taking LEXAPRO, a patient might feel little change, unless there are some initial side effects (which generally disappear after 7 to 14 days). For most patients, it takes at least a week or two before they feel any improvement. Full antidepressant effect may take 4 to 6 weeks.

In general, emotional improvement is gradual, and realized by looking back over the past several days and noting "you know, I am starting to feel less hopeless, despondent, and depressed." It is also common to begin to have some "good" days only to have them followed by some "not so good" ones. Patients should not feel discouraged by the "blue" days, but rather encouraged by the "good ones", as they indicate that recovery is beginning.

In clinical trials, LEXAPRO was shown to be well tolerated by most people with many of the side effects disappearing in the first few weeks.

The most common adverse events reported with LEXAPRO vs placebo (approximately 5% or greater and approximately 2X placebo) were nausea, insomnia, ejaculation disorder, somnolence, increased sweating, fatigue, decreased libido, and anorgasmia. LEXAPRO is contraindicated in patients taking monoamine oxidase inhibitors (MAOIs) or in patients with a hypersensitivity to escitalopram oxalate or any of the ingredients in LEXAPRO. Lexapro is contraindicated in patients taking pimozide (see DRUG INTERACTIONS - Pimozide and Celexa). As with other SSRIs, caution is indicated in the coadministration of tricyclic antidepressants (TCAs) with LEXAPRO. As with other psychotropic drugs that interfere with serotonin reuptake, patients should be cautioned regarding the risk of bleeding associated with the concomitant use of LEXAPRO with NSAIDs, aspirin, or other drugs that affect coagulation. Patients with major depressive disorder, both adult and pediatric, may experience worsening of their depression and/or the emergence of suicidal ideation and behavior (suicidality), whether or not they are taking antidepressant medications, and this risk may persist until significant remission occurs. Although no causal role for antidepressants in inducing such behaviors has been established, patients being treated with antidepressants should be observed closely for clinical worsening and suicidality, especially at the beginning of a course of drug therapy, or at the time of dose changes, either increases or decreases.

For more information, see the side effects section.

Q: What if you miss a dose of Lexapro? How will that make you feel and what should you do about it?

A: For most patients, one missed dose of LEXAPRO doesn't cause many symptoms. If it is the same day when you realize you have missed a dose, take it then. If it is the next day, take the usual dose for that day. In general, it is not necessary to "catch up" by taking extra doses to make up for the one missed. Try not to miss doses of medication. Take them daily and regularly for as long as your doctor prescribes. This may be for several months after recovery from your depressive symptoms. This is to help keep your depression from coming back.

One other word of caution: Always consult with your physician before discontinuing your antidepressant medication.

Q: If you are switching from another antidepressant to LEXAPRO or vice versa, what should you keep in mind? What is entailed in the switchover? Can you switch from Celexa to LEXAPRO without a waiting period?

A: Although several antidepressants work by increasing the effectiveness of the brain neurotransmitter serotonin, these medications do not look alike structurally. Therefore, one SSRI may work in a single patient, whereas another SSRI (working on the same brain "juice," serotonin) may not work for that patient, and thus a switch may be necessary. Studies show that up to 50% of patients not responding to one SSRI may respond to another.

In general, patients can be switched from one SSRI to another without a waiting period in-between. This is no different for patients on Celexa. However, due to serotonin discontinuation symptoms, it is probably best to taper off one SSRI instead of just stopping it abruptly. I generally start patients on LEXAPRO while I taper off the other antidepressant, but other physicians may suggest tapering off the first, before starting the second. There is very little danger in overlapping the drugs for a short time, however.

next: LEXAPRO FAQS: Treatment Effectiveness of Lexapro