Escitalopram is an oral drug that is used for treating depression and generalized anxiety disorder. It works by affecting neurotransmitters in the brain, the chemical messengers that nerves use to communicate with one another. Neurotransmitters are made and released by nerves and then travel to other nearby nerves where they attach to receptors on the nerves. Some neurotransmitters that are released do not bind to receptors and are taken up by the nerves that produced them. This is referred to as "reuptake."  

How does Escitalopram work?

Many experts believe that an imbalance of neurotransmitters is the cause of depression. Escitalopram prevents the reuptake of one neurotransmitter, serotonin, by nerves, an action which results in more serotonin in the brain to attach to receptors. Chemically, escitalopram is very similar to citalopram. Both are in the class of drugs called selective serotonin reuptake inhibitors (SSRIs), a class that also includes fluoxetine (Prozac), paroxetine (Paxil) and sertraline (Zoloft).

What is Escitalopram prescribed for?

Escitalopram is approved for the treatment of depression and generalized anxiety disorder. Drugs in the SSRI class also have been studied in persons with obsessive-compulsive disorders and panic disorders.

Escitalopram provides relief for anxiety disordersPatients taking the medication show significant improvement

Escitalopram oxalate provides significant relief for people with anxiety disorders, according to three studies presented at the 2002 annual meeting of the Anxiety Disorders Association of America (ADAA). The studies demonstrate that Escitalopram oxalate reduces symptoms and improves quality of life for people with panic disorder, social anxiety disorder, and generalized anxiety disorder. Escitalopram oxalate developed by Forest Laboratories, Inc., is the single-active isomer of citalopram HBr. Both are selective serotonin reuptake inhibitors (SSRIs).

Patients with social anxiety disorder showed significant improvement while taking Lepraxo during a 12-week study at the University Hospital of Vienna, Austria. The 358 study participants, including men and women, ages 18 - 65, were given either Lexapro or a placebo during the study. To assess the participants' symptoms, researchers used several measurement tools, primarily the Liebowitz Social Anxiety Scale (LSAS). Together, these tools measured the participants' fear and avoidance in social situations; severity and improvement of symptoms; and ability to cope with everyday activities. Significant improvement was demonstrated in all areas for participants taking Lexapro compared with those taking the placebo.

Escitalopram and panic disorderIn a study of 247 people with panic disorder (with or without agoraphobia), researchers at the University of California, San Diego, found that Escitalopram oxalate significantly reduced symptoms of panic disorder, including panic attack frequency and severity, anticipatory anxiety, and phobic avoidance. According to the study, symptoms improved significantly within four weeks. Researchers found that the quality of life for patients taking Escitalopram oxalate  also improved. Study participants included both men and women, ages 18 - 80, who received either Escitalopram oxalate or a placebo during the 12-week study. Researchers used several assessment tools to monitor the participants' symptoms, including the Modified Sheehan Panic and Anticipatory Anxiety Scale, the Panic and Agoraphobia Scale, the Hamilton Anxiety Scale, Clinical and Global Impressions Scale, Patient Global Evaluation, and the Quality of Life Questionnaire. 

Escitalopram dosing

The usual starting dose of escitalopram is 10 mg once daily. Benefit may not be seen until treatment has been given for up to 4 weeks. Escitalopram can be taken with or without food. Older and younger persons require similar doses.

Escitalopram interactions

All SSRIs, including escitalopram, should not be taken together with any drugs of the MAO (mono-amine oxidase) inhibitor-class of antidepressants, for example, isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate), and procarbazine (Matulane). Such combinations may lead to confusion, high blood pressure, high fevers, tremor or muscle rigidity, and increased activity. This same type of interaction also may occur with selegiline (Eldepryl), fenfluramine (Pondimin), and dexfenfluramine (Redux). Tryptophan can cause headaches, nausea, sweating, and dizziness when taken with any SSRI. At least 14 days should elapse after discontinuing escitalopram before starting a MAO inhibitor.

Escitalopram and pregnancy

The safety of escitalopram during pregnancy and lactation has not been established. Therefore, escitalopram should not be used during pregnancy unless, in the opinion of the physician, the expected benefits to the patient outweigh the possible hazards to the fetus.

Escitalopram and nursing mothers

Escitalopram is excreted in human milk. Escitalopram should not be given to nursing mothers unless, in the opinion of the physician, the expected benefits to the patient outweigh the possible hazards to the child.

Escitalopram side effects:

The most commonly-noted side effects associated with escitalopram are agitation or restlessness, blurred vision, diarrhea, difficulty sleeping, drowsiness, dry mouth, fever, frequent urination, headache, indigestion, nausea, increased or decreased appetite, increased sweating, sexual difficulties (decreased sexual ability or desire, ejaculatory delay), taste alterations, tremor (shaking), weight changes. Although changes in sexual desire, sexual performance and sexual satisfaction often occur as a result of depression itself, they also may be a consequence of the drugs used to treat depression. In particular, about one in 11 men given escitalopram report difficulties experiencing ejaculation.

Some patients may experience withdrawal reactions upon stopping SSRI therapy. Symptoms may include dizziness, tingling, tiredness, vivid dreams, irritability, or poor mood. In order to avoid these symptoms, the dose of SSRI can be slowly reduced instead of abruptly stopped. 

It has been suggested that SSRIs may cause depression to worsen and even lead to suicide in a small number of patients. These potential side effects are difficult to evaluate in depressed patients because depression can progress with or without treatment, and suicide is itself a consequence of depression. Moreover, the evidence supporting these potential side effects is weak. Therefore, no conclusions can yet be drawn about the relationship between SSRIs and worsening depression and suicide. Until better information is available, patients receiving SSRIs should be monitored for worsening depression and suicidal tendencies. 

Disclaimer:

Information on this page is provided for general information purposes. You should not make a clinical treatment decision based on information contained in this page without consulting other references including the package insert of the drug, textbooks and where relevant, expert opinion. We cannot be held responsible for any errors you make in administering drugs mentioned on this page, nor for use of any erroneous information contained on this page.