Side Effects Of Lexapro: What You Should Know

Lexapro, also known as escitalopram oxalate, is a Selective Serotonin Reuptake Inhibitor (SSRI) that doctors primarily prescribe to manage symptoms related to Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD). Its mechanism of action involves increasing serotonergic transmission in the central nervous system. It eases the symptoms of Major Depression and Generalized Anxiety.  However, Serotonin does not solely act on receptors responsible for depression and anxiety. It also affects receptors that regulate appetite, sexual function, and sleep. As a result, the increased serotonergic activity impacts the regulation of these physiological processes in our bodies. And causes the associated side effects of using escitalopram. This article will explore the common side effects of lexapro that patients should be aware of when taking Escitalopram.

Lexapro’s Most Frequently Occurring Side Effects

Escitalopram is a derivative of a slightly older SSRI, Citalopram. The distinguishing factor between the two drugs lies in their composition. Escitalopram contains the most functional and serotonin-selective enantiomer. This feature is crucial because it implies that the side effects of Lexapro are not related to the drug’s actions. As it solely affects serotonin, but rather to the elevated levels of serotonin brought about by its therapeutic effects. 

Thus, most of the side effects of Lexapro are dependent on the dose. Additionally, if experienced, the worst Lexapro side effects tend to occur in the first week as the body has not had enough time to adapt physiologically to the newly elevated levels of serotonin. And you have to take the precaution for it. Nevertheless, as the body adapts, many of the most frequent side effects of Lexapro will lessen or become more tolerable.

Frequently Occurring Side Effects of Lexapro Consist of:

Here are the explanations of the different types of Escitalopram side effects. As per the prescribing information for Lexapro provided by the FDA:

• Constitutional: These are symptoms related to the general well-being of the patient, including fatigue and flu-like symptoms.

• Autonomic Nervous System: These are symptoms related to the involuntary functions of the body, such as the dry mouth and excessive sweating.

• Central and Peripheral Nervous System: These are symptoms related to the brain and nerves, such as headache, dizziness, and tingling or numbness in the extremities.

• Gastrointestinal: These are symptoms related to the digestive system, including nausea, diarrhea, constipation, indigestion, abdominal pain, vomiting, flatulence, and toothache.

• Psychiatric Disorders: These are symptoms related to mental health, such as insomnia, drowsiness, ringing in the ears (tinnitus), loss of appetite, and loss of libido.

• Respiratory Disorders: These are symptoms related to the respiratory system, including runny or stuffy nose (rhinitis), sinus infection (sinusitis), and excessive yawning.

• Urogenital: These are symptoms related to the urinary and reproductive systems. It includes ejaculation disorders, impotence, anorgasmia (inability to orgasm), and menstrual disorders.

Additionally, there are various other Lexapro side effects that patients have reported during premarketing and marketing periods. However, since these adverse reactions occur with very low frequencies (<1%) and are self-reported, their frequency and causal connection cannot be reliably estimated.

Severe Side Effects of Escitalopram

Here are the points explaining the severe side effects of Escitalopram in active voice:

• Life-threatening emergent side effects of Lexapro are rare. And associated with various conditions and syndromes that may arise from its therapy.
• Patients should immediately contact their physician or emergency medical services if they experience any of the following symptoms:
• A painful erection lasting more than 4 hours (Priapism)
• Extreme dizziness or fainting (Syncope)
• Irretractable bleeding from nose, gums, or cuts, easy bruising
• Coughing up blood, vomiting blood, or blood in stool or urine
• Hyponatremia presents with a constant headache, confusion, weakness, muscle cramps, or seizures
• Suicidal thoughts
• High temperature , agitation, confusion, twitching, trembling
• Serious allergic reactions presenting with an itchy, red, swollen, or blistering rash; trouble breathing and wheezing; tightness in the chest or throat. Also, swelling in the mouth, tongue, lips, face, or throat.
• Escitalopram withdrawal syndrome and overdose can also cause additional life-threatening side effects. If you suddenly stops the use of Lexapro or you take it more often.
• Patients should always take Escitalopram exactly as directed by their physician. And should not make any alterations to their dosage without consulting their physician first.

Lexapro Weight Loss

As previously noted, Serotonin regulates not only physiological processes related to depression and anxiety but also those related to appetite and satiety. This regulation suppresses appetite and curbs hunger. The Monoamine Hypothesis in Major Depressive Disorder(MDD) suggests that a deficiency in Serotonin levels disrupts the regulation of appetite and hunger. It can explain why some subsets of Major Depression are associated with increased appetite, hyperphagia, and weight gain. Escitalopram therapy restores and elevates the levels of Serotonin in our bodies, leading to suppressed appetite and decreased hunger, resulting in weight loss. As a result, Lexapro weight loss has been reported in certain subsets of patients during initial therapy. However, this effect is temporary, and most patients regain the lost weight within 6 months.

Lexapro Weight Gain

As previously established, Serotonin has a significant impact on appetite and hunger regulation. Although initial therapy with SSRIs like Escitalopram can result in weight loss, long-term use has been linked to weight gain. The United States National Library of Medicine has identified increased appetite as one of the adverse reactions to Escitalopram, which may explain the associated Lexapro Weight Gain. However, as Serotonin naturally suppresses appetite and hunger, a different mechanism must be responsible for this increase in appetite. Furthermore, the peripheral effects of elevated serotonin levels in the body, rather than central effects, may better explain why certain patients experience weight gain with continued SSRI therapy.

Factors that may contribute to weight gain observed in individuals taking Lexapro

• Patients could experience weight gain due to appetite increase, which is believed to be related more to the patient feeling better with alleviation of depressive symptoms rather than a direct effect of the medication or its therapeutic effect, due to Lexapro mechanism of action.
• Serotonin has peripheral effects on the gastrointestinal tract, which could explain why patients could experience some weight gain. Serotonin promotes intestinal motility in the gut, increasing the total fat absorption. It also promotes insulin release in the pancreas, increasing adipogenesis and lipogenesis while suppressing lipolysis. Serotonin promotes Gluconeogenesis, Lipogenesis, and fat deposition in the liver. Additionally, Serotonin promotes the synthesis of White Adipose Tissue (WAT), which is the storage form of fats and prevents the catabolism of the same WAT.
• The weight gain observed in some patients who use Lexapro for an extended period may be due to the collective effect of serotonin, which promotes lipid synthesis and deposition of fatty tissue.

Discontinuing Lexapro Because of Negative Side Effects

Lexapro Withdrawal Syndrome was previously mentioned, which occurs in patients who have been taking Escitalopram for an extended period of time and have adapted physiologically. Abrupt discontinuation of Escitalopram can cause a transient deficiency of serotonin and its activity leading to the characteristic signs and symptoms of withdrawal. Patients experiencing adverse reactions to Lexapro and wishing to discontinue its use should not do so on their own and should consult their physician for information on the best way to discontinue the medication.

Strategies for Coping with Weight Changes Associated with Lexapro Use

• Patients may not experience weight changes during therapy with SSRIs, and the severity of the changes varies among patients.
• If patients do experience weight changes that are concerning to them, several strategies can employ to help cope with these changes, including:
  • Dietary changes, such as reducing high-fat and high-calorie foods, eating smaller portions, and adopting low- and very-low-calorie diets.
  • Cognitive-behavioral therapy, which can help patients identify behaviors that need modification, set goals, and address triggers of excessive eating.
  • Switching to another type of antidepressant that has fewer or no weight-related reactions, as advised by a medical doctor.
• It’s essential to remember that Lexapro withdrawal can occur, and patients should not discontinue Escitalopram use without consulting their physician for guidance on how to safely discontinue Lexapro use.

Escitalopram-Induced Sexual Dysfunction as a Side Effect

Selective Serotonin Reuptake Inhibitors (SSRIs), including Lexapro, are associated with sexual dysfunction. It is a common but under-discussed and under-reported side effect. The exact cause of this sexual dysfunction is unknown. Although many believed that elevated levels of Serotonin may have an impact on other hormones (such as testosterone), peptides (such as Nitric Oxide), and neurotransmitters (such as Dopamine), which play an important role in sexual desire, arousal, and orgasm. Up to 40-65% of patients taking SSRIs have reported experiencing sexual dysfunction as a side effect within days to weeks after starting therapy.

Some of the reported adverse reactions are:

• Men taking Lexapro may experience the following sexual side effects: delayed ejaculation, delayed orgasm, anorgasmia, erectile dysfunction, reduced libido, reduced sexual satisfaction, and priapism.
• Women taking Lexapro may experience the following sexual side effects: reduced lubrication, reduced sexual satisfaction, reduced libido, and anorgasmia.
• The type and severity of sexual dysfunction caused by Lexapro can vary based on gender.
• Women with Major Depression are more likely to experience a greater reduction in sexual desire and difficulties with orgasm compared to men.
• Women tend to experience a variable degree of improvement in sexual dysfunction with continued therapy with SSRIs, while men are more likely to experience anorgasmia, delayed ejaculation, and erectile dysfunction.
• In men, these effects are less likely to improve with continued therapy with SSRIs.

Strategies for Coping with Sexual Side Effects of Escitalopram

It is important to acknowledge Escitalopram-induced sexual dysfunctions. As they have been reported to cause 41.7% of men and 15.4% of women to stop taking psychiatric medications. This is particularly concerning as sexual dysfunction may act as an instigator of Major Depression and hinder long-term therapy adherence, which is crucial for SSRIs.

To effectively manage these side effects, an assessment should conduct to determine. If the sexual dysfunction caused by the antidepressant treatment or attributed to Major Depression, which can also have similar effects. Establishing a baseline level of sexual functioning before starting SSRIs is optimal. Once established, the next challenge is to manage the dysfunction without causing undesirable mental consequences for the patient.

Managing the Sexual Dysfunction Associated With Escitalopram Use can be approached through five general methods:

• Wait and See: Patients may choose to endure the sexual dysfunction caused by Escitalopram as it may resolve on its own with continued use of the medication. However, patients should be aware that concurrent alcohol consumption can delay the resolution of these effects.
• Reducing Drug Dosage: Lowering the dose of Escitalopram can potentially alleviate some of the sexual dysfunction experienced by patients. However, it is important for patients to always consult with their healthcare provider before making any changes to their medication.
• Drug Holidays: Patients may consider taking a break from medication, known as a “drug holiday,” after consulting with their healthcare provider. It is essential for patients to never stop taking. Or altering the dosage of their antidepressants without consulting their doctor first.
• Switching Medications: Alternative medications such as Bupropion, Mirtazapine, Vilazodone, and Vortioxetine have different mechanisms of action than SSRIs. And may lower the risk of sexual dysfunction. Patients can discuss the possibility of switching to one of these medications with their healthcare provider.
• Adjuncts: Addition of a Phosphodiesterase (PDE) 5 Inhibitor such as sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra) may improve Erectile Dysfunction in men. However, their role in alleviating sexual dysfunction in women taking SSRIs is unclear.

In addition to the above strategies, educating patients about the sexual adverse reactions of SSRIs. Like Escitalopram is critical for successful treatment and long-term adherence. Patients should also be reminded never to stop taking or alter the dosage of their medication without consulting their healthcare provider. Regardless of the severity of the side effects.

Summary

Escitalopram is an SSRI antidepressant that is used to treat depression and anxiety disorders. However, like all medications, it can cause a variety of side effects. It includes sexual dysfunction, hyponatremia, serotonin syndrome, bleeding risk, and allergic reactions. The emergence of these side effects can impact the factors such as dose, frequency, genetics, metabolism, age, gender, weight, and comorbidities.

While some of these side effects cannot be altered. There are steps that patients can take to reduce or mitigate certain side effects. For example, dry mouth can be managed with sugar-free gum or candies, hyperhidrosis with antiperspirants or laser treatment. Also, insomnia with taking the medication earlier in the day, and nausea with frequent small meals and staying hydrated. Patients may also benefit from cognitive behavioral therapy to help manage undesired thoughts and behaviors.

It’s important to note the patients should never stop taking or alter the dose of Escitalopram on their own. Even if they are experiencing unbearable side effects. Rather, they should need consult with their physician before making any changes to their treatment plan.