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Escitalopram – Uses, Dosage and Side Effects
Escitalopram is an antidepressant belonging to the class of selective serotonin reuptake inhibitors (SSRIs), used to treat depression and anxiety disorders.
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Escitalopram is an antidepressant belonging to the class of selective serotonin reuptake inhibitors (SSRIs), used to treat depression and anxiety disorders.
What is Escitalopram?
Escitalopram is a prescription medication belonging to the class of selective serotonin reuptake inhibitors (SSRIs). It is one of the most widely prescribed antidepressants worldwide and is used to treat depression and various anxiety disorders. Escitalopram is the pharmacologically active enantiomer of citalopram and is considered to have a particularly favorable tolerability profile.
Indications
Escitalopram is approved for the treatment of the following conditions:
- Major depressive disorder (MDD)
- Generalized anxiety disorder (GAD)
- Social anxiety disorder (social phobia)
- Panic disorder – with or without agoraphobia
- Obsessive-compulsive disorder (OCD)
Mechanism of Action
Escitalopram selectively inhibits the serotonin transporter (SERT) in the brain. This transporter is responsible for removing serotonin from the synaptic cleft and returning it to the presynaptic neuron. By blocking this transporter, more serotonin remains available in the synapse, thereby enhancing serotonergic neurotransmission. Serotonin is a neurotransmitter that plays a key role in regulating mood, anxiety, sleep, and emotional well-being.
Compared to other SSRIs, escitalopram shows very high selectivity and affinity for the serotonin transporter and has minimal activity at other receptors (e.g., histamine, muscarinic receptors), which explains its favorable side effect profile.
Dosage
The dosage of escitalopram depends on the indication, the age of the patient, and individual tolerability. General guidelines include:
- Adults: Starting dose is typically 10 mg once daily; may be increased to a maximum of 20 mg per day based on response
- Elderly patients (over 65 years): Recommended maximum dose is usually 10 mg per day
- Adolescents (from 12 years): Approved in some countries for OCD, starting at 10 mg
- Escitalopram is generally taken once daily, with or without food
The full therapeutic effect often takes 2 to 4 weeks to become apparent. Discontinuation should always be done gradually and under medical supervision to avoid withdrawal symptoms.
Side Effects
Escitalopram is generally well tolerated. Possible side effects include:
Common Side Effects
- Nausea, diarrhea, or constipation
- Headache
- Sleep disturbances (insomnia or drowsiness)
- Dry mouth
- Sweating
- Sexual dysfunction (e.g., decreased libido, delayed orgasm)
Rare but Important Side Effects
- Serotonin syndrome: A potentially life-threatening reaction occurring with overdose or combination with other serotonergic substances (symptoms: confusion, tremor, fever, muscle rigidity)
- QT interval prolongation: Changes in cardiac electrical activity, particularly at higher doses – caution in patients with pre-existing heart conditions
- Hyponatremia: Low blood sodium levels, especially in elderly patients
- Increased bleeding risk (e.g., when taken with blood thinners)
Drug Interactions
Escitalopram can interact with various medications. Key interactions include:
- MAO inhibitors (e.g., phenelzine, tranylcypromine): Combination is contraindicated – high risk of serotonin syndrome
- Other serotonergic substances (e.g., tramadol, triptans, St. John's Wort): increased risk of serotonin syndrome
- QT-prolonging drugs (e.g., certain antibiotics, antiarrhythmics): additive risk of cardiac arrhythmias
- Blood thinners (e.g., warfarin, aspirin): increased bleeding risk
Usage Notes
Escitalopram should not be stopped abruptly. A gradual tapering under medical supervision is necessary to avoid discontinuation symptoms such as dizziness, irritability, tingling sensations, or flu-like symptoms. In the initial weeks of treatment, a temporary increase in anxiety symptoms may occur. Patients under the age of 25 should be closely monitored for suicidal thoughts at the start of therapy.
References
- National Institute for Health and Care Excellence (NICE) – Depression in adults: treatment and management. NICE guideline NG222 (2022). Available at: www.nice.org.uk
- European Medicines Agency (EMA) – Summary of Product Characteristics: Escitalopram (2023). Available at: www.ema.europa.eu
- Cipriani A et al. – Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder. The Lancet, 2018; 391(10128): 1357–1366
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