A Guide to Lexapro Side Effects

What is Lexapro used for?

While talk therapy remains a cornerstone of mental health treatment, certain conditions often require additional support. For individuals with major depressive disorder (MDD) or generalized anxiety disorder (GAD), combining psychotherapy with medication, particularly selective serotonin reuptake inhibitors (SSRIs), can significantly enhance symptom relief and recovery outcomes.

Among the most widely prescribed SSRIs are escitalopram, sertraline, and paroxetine. All three outperform placebo in clinical trials, but escitalopram (Lexapro) may offer greater efficacy compared to several other antidepressant options (Sanchez et al., 2014).

This guide focuses on Lexapro, the brand name for escitalopram. If you're working in clinical care, chances are you've prescribed it, or you're currently managing patients who are taking it.

Lexapro is FDA-approved to treat:

• Major depressive disorder (MDD) in adults and adolescents aged 12 and older
• Generalized anxiety disorder (GAD) in both adult and adolescent populations

Clinicians often choose Lexapro when treating patients who present with co-occurring symptoms of depression and anxiety, or when a well-tolerated, first-line pharmacological option is preferred.

Though not officially approved for it, Lexapro has also demonstrated effectiveness in treating obsessive-compulsive disorder (OCD) (Jenike, n.d.), making it a consideration in off-label contexts when appropriate.

Minor Lexapro side effects

Lexapro is one of the go-to medications because it’s generally well-tolerated, has a relatively favorable side effect profile, and is approved for both adults and adolescents. However, while there are clear advantages to using Lexapro, it’s just as important to revisit potential side effects and help patients manage them effectively.

Common minor side effects include, but are not limited to, the following:

• Gastrointestinal issues such as nausea, stomach pain, gas, diarrhea, or constipation
• Neurological symptoms include dizziness, fatigue, unusual drowsiness, trouble sleeping, and headache
• Sexual problems like reduced libido, erectile dysfunction, and difficulty with ejaculation or orgasm
• Mood and physical changes such as increased anxiety, flu-like symptoms, and sweating
• Appetite and weight fluctuations, including changes in eating habits and possible weight gain
• Other symptoms, such as dry mouth and muscle twitching

Lexapro side effects are typically mild and tend to ease as your patient adjusts to the medication. Due to how medication affects the patient, it’s also important to have them avoid alcohol, as it is a central nervous system depressant.

Lexapro is one of the go-to medications because it’s generally well-tolerated, has a relatively favorable side effect profile, and is approved for both adults and adolescents. However, while there are clear advantages to using Lexapro, it’s just as important to revisit potential side effects and help patients manage them effectively.

Serious Lexapro side effects

While Lexapro is generally well-tolerated, it’s important to monitor patients carefully, especially during the early stages of treatment. Serious side effects may include:

• Increased risk of suicidal thoughts and behavior in pediatric and young adults
• Worsening depression or sudden mood changes
• Seizures, more likely if a patient has a history of such
• Serotonin syndrome, if taken with monoamine oxidase inhibitors (MAOIs) or other medications, with symptoms such as confusion, rapid heartbeat, high fever, and muscle stiffness
• Risk of unusual bleeding, especially when combined with nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin, or blood thinners
• Caution in patients with kidney disease due to altered medication metabolism

Proper patient education and ongoing monitoring help manage these risks and promote safe use of Lexapro.

How to manage and mitigate side effects

When Lexapro is used to treat depression or anxiety, a little proactive care can go a long way in keeping patients on track and improving their overall experience with the medication. Aside from guiding patients through the prescription label, here are some things you can do:

Start with a low dose

Jumping into a full dose right away can overwhelm the system, especially for first-time SSRI users. Start with a lower dose. Gradually increase it to allow the body to adjust more gently.

For example, easing in with 5 mg before stepping up to 10 mg can reduce early side effects like jitteriness or nausea, making the experience less discouraging for the patient. Dosage forms can be in tablet or oral solution.

Set expectations early

Some patients stop taking their meds at the first sign of discomfort simply because they didn’t know what to expect. Having an open, honest conversation about what may happen in the first couple of weeks, like mild headaches or sleep issues, can make them feel more in control.

When patients feel prepared, they’re more likely to stick with the plan and give the medication a fair shot.

Help manage side effects while they’re happening

Not every side effect fades on its own, but that doesn’t always mean you have to switch medications. Sometimes small adjustments can make a big difference.

If Lexapro is causing fatigue and trouble sleeping, shifting the dose to the evening might help. If it’s causing stomach upset, taking it with food could ease that. It’s about tuning in to your patient’s experience and making thoughtful tweaks along the way.

Keep an eye on other medications

When multiple prescriptions are involved, the potential for interaction grows. Be wary of drug interactions as Lexapro can interact with others, like NSAIDs or other antidepressants, in ways that increase risk.

Regular medication reviews and close communication with the patient’s full care team help you catch these issues early and adjust accordingly. Note some allergic reactions too.

Prepare for discontinuation

If and when it’s time to discontinue Lexapro, the process needs just as much care. Patients who suddenly stop taking escitalopram, like Lexapro, may experience withdrawal symptoms like dizziness, mood swings, or flu-like discomfort.

A gradual taper, planned in collaboration with the patient and paced according to how they're feeling, helps reduce these effects and gives them a smoother transition, especially after long-term use.

Example of a Lexapro side effect management plan

This is a fictional patient case created solely for educational purposes and to illustrate an example of a Lexapro side effect management plan.

Client name: John Wort  DOB: 1/1/1991
Age: 34  Date: 1/11/2025
Diagnosis: Generalized anxiety disorder

Problem: Management of Lexapro side effects

John has recently started Lexapro and is experiencing mild side effects such as nausea, fatigue, and dry mouth. These side effects are causing discomfort and may affect his willingness to continue the medication.

Goal: Within 60 days, John will manage side effects effectively to maintain medication adherence and improve comfort.

Objective 1: John will learn about common Lexapro side effects and ways to reduce their impact within 30 days.

Intervention: Educate John about common side effects and advise taking medication with food and staying hydrated. Recommend taking it at bedtime if possible and avoiding driving or operating machinery until effects are clear.

Objective 2: John will communicate side effect experiences with his healthcare provider to explore possible adjustments within 60 days.

Intervention 2: Encourage John to keep a symptom diary and discuss findings during follow-up appointments for informed medication management.

References

Jenike, M. (n.d.). Medications for OCD. International OCD Foundation. https://iocdf.org/about-ocd/treatment/meds

Sanchez, C., Reines, E. H., & Montgomery, S. A. (2014). A comparative review of escitalopram, paroxetine, and sertraline. International Clinical Psychopharmacology, 29(4), 185–196. https://doi.org/10.1097/yic.0000000000000023