The standard starting dose of Lexapro (escitalopram) is 10 mg once daily, taken either in the morning or evening. Most prescribers keep you at this dose for at least one week before considering any increase, and the maximum is 20 mg per day. Here’s what to expect as you begin and how to set yourself up for the smoothest possible start.
How Lexapro Works
Lexapro is a selective serotonin reuptake inhibitor, or SSRI. It blocks your brain’s recycling of serotonin, a chemical messenger involved in mood and anxiety regulation. The result is more serotonin available between nerve cells. This sounds simple, but your brain needs time to adjust to the new balance, which is why the medication doesn’t work overnight and why the first week or two can feel bumpy.
The Typical Starting Dose
For both major depression and generalized anxiety disorder in adults, the recommended starting dose is 10 mg once a day. Some prescribers start patients at 5 mg for the first few days, then move to 10 mg, especially if you’re sensitive to medication or prone to anxiety spikes. This isn’t an official FDA-labeled step, but it’s a common real-world approach.
If 10 mg isn’t enough after at least one week, your prescriber may raise you to 20 mg. For adolescents being treated for depression, that waiting period is longer: a minimum of three weeks before any increase. The dose cap remains 20 mg per day regardless of age or condition.
Morning or Evening: When to Take It
Lexapro can be taken in the morning or evening, with or without food. The best time depends on how the medication affects you personally. If it makes you drowsy, taking it at bedtime keeps that side effect out of your daytime hours. If it gives you a burst of energy or makes falling asleep harder, morning dosing is the better choice. Pick a consistent time and stick with it so the drug stays at a steady level in your system.
What the First Two Weeks Feel Like
The first one to two weeks are an adjustment period. Your body is reacting to shifting serotonin levels before the therapeutic benefits fully kick in. During this window you may notice improvements in sleep, energy, and appetite, but the full effect on mood and anxiety typically takes four to six weeks.
Common side effects in the early days include headaches, nausea, drowsiness, and changes in sexual function. Headaches tend to resolve after the first week. Sexual side effects usually ease within the first couple of weeks as well. Most of these early reactions fade as your body adapts.
The Temporary Anxiety Spike
One of the most unsettling things about starting Lexapro is that anxiety can temporarily get worse before it gets better. Fluctuating serotonin levels in the early days of treatment can trigger what’s sometimes called jitteriness syndrome. A 2014 study found that roughly 7% of people developed noticeable anxiety after one month on an antidepressant. It’s not a sign the medication is wrong for you. It’s a known transitional effect.
If it happens, a few things can help. Deep breathing and progressive muscle relaxation take the edge off acute flare-ups. Keeping a regular eating schedule and cutting back on caffeine, high-sugar foods, and heavily processed snacks can also reduce background anxiety. If the spike is severe, your prescriber may temporarily lower the dose and increase it more gradually, or briefly add a short-acting anti-anxiety medication to bridge the gap.
Alcohol and Other Interactions
Lexapro and alcohol are a poor combination. Alcohol can blunt the antidepressant’s benefits, making your symptoms harder to treat. It also amplifies side effects like drowsiness and impaired coordination far more than either substance would on its own. If you drink, keep it minimal, and pay close attention to how even small amounts affect you while you’re adjusting to the medication.
There are no specific food restrictions with Lexapro (unlike older antidepressants called MAOIs, which require a strict diet). However, Lexapro should never be combined with MAOIs or taken within 14 days of stopping one, because the interaction can cause serotonin syndrome, a potentially dangerous buildup of serotonin. Make sure your prescriber has a complete list of everything you take, including supplements.
If You Miss a Dose
Take the missed dose as soon as you remember, unless it’s close to the time for your next one. In that case, skip the missed dose and go back to your regular schedule. Don’t double up. Setting a daily alarm on your phone is the simplest way to stay consistent, especially during the first few weeks when the habit hasn’t formed yet.
What to Watch For in the Early Weeks
All antidepressants carry an FDA boxed warning about an increased risk of suicidal thoughts and behaviors in people under 25 during the early phase of treatment. This doesn’t mean the medication causes suicidal behavior in most people, but it does mean close monitoring matters. If you notice a sudden shift in mood, new or worsening thoughts of self-harm, unusual agitation, or impulsive behavior, contact your prescriber right away. These changes are most likely to appear in the first few weeks or after a dose change.
It helps to keep a simple daily log of your mood, sleep, and any side effects. This gives both you and your prescriber concrete data to work with at follow-up appointments, rather than relying on memory.
Planning Ahead: Why You Can’t Stop Abruptly
Even though you’re just starting, it’s worth knowing now that Lexapro is not a medication you stop cold turkey. If you’ve taken it for six weeks or more, suddenly quitting can cause discontinuation syndrome: a cluster of physical and mood-related symptoms driven by a sudden drop in serotonin. Escitalopram carries a moderate risk for this compared to other SSRIs. When the time comes to stop, your prescriber will design a gradual taper that lowers your dose over weeks or months. Never adjust your dose or stop on your own.
The practical takeaway: starting Lexapro is straightforward. Take your prescribed dose at the same time each day, give it a full four to six weeks before judging whether it’s working, and stay in contact with your prescriber through the adjustment period. The rough edges of the first two weeks are temporary and, for most people, well worth pushing through.