Yes, Lexapro (escitalopram) is FDA-approved for treating generalized anxiety disorder (GAD) in adults. It’s one of the most commonly prescribed medications for anxiety and is also approved for major depressive disorder. In clinical trials, 58% of people with GAD who took Lexapro saw a meaningful reduction in anxiety symptoms, compared to 38% on placebo.
How Lexapro Reduces Anxiety
Lexapro belongs to a class of medications called SSRIs, or selective serotonin reuptake inhibitors. Normally, after nerve cells in your brain release serotonin to send a signal, they reabsorb it. Lexapro blocks that reabsorption, leaving more serotonin available in the gaps between nerve cells. This increased serotonin activity is what gradually reduces anxiety symptoms.
Lexapro is the more refined version of an older drug called Celexa (citalopram). Celexa contains two mirror-image forms of the same molecule, but only one of them is therapeutically active. Lexapro contains only that active form, which is why it can work at lower doses and tends to cause fewer side effects.
How Well It Works
In a randomized, double-blind trial of people with generalized anxiety disorder, those taking Lexapro improved significantly more than those on placebo. After eight weeks, anxiety scores dropped by an average of 11.3 points on a standard clinical scale, compared to 7.4 points for placebo. Among people who completed the full trial, 68% responded to Lexapro versus 41% on placebo.
Comparative reviews have found that Lexapro frequently outperforms other common SSRIs. Meta-analyses show higher response and remission rates compared to paroxetine (Paxil) and sertraline (Zoloft), particularly in patients with significant anxiety. Lexapro and sertraline have similar tolerability, while paroxetine tends to cause more side effects like sedation, sexual dysfunction, and constipation. Sertraline is more likely to cause diarrhea than Lexapro.
How Long It Takes to Work
Lexapro doesn’t provide immediate relief. Some people notice early changes in sleep quality, energy, or appetite within one to two weeks, but these aren’t the same as full anxiety relief. The core symptoms of anxiety, like persistent worry, restlessness, and difficulty concentrating, typically take six to eight weeks to fully improve.
This timeline can be frustrating, and some people assume the medication isn’t working after a few weeks. Staying on it through the full initial period is important before evaluating whether it’s effective. Your prescriber will likely check in around the four- to six-week mark to assess progress.
What Starting Treatment Looks Like
The standard starting dose for anxiety is 10 mg once daily. Unlike its use for depression, where the dose can go up to 20 mg, the recommended maximum for generalized anxiety disorder is 10 mg per day. If a dose increase is needed for other conditions, prescribers typically wait at least one week before adjusting.
You can take Lexapro in the morning or evening, with or without food. Some people find it mildly energizing and prefer mornings, while others experience drowsiness and take it at night. Either approach is fine.
Common Side Effects
Most side effects are mild and tend to appear in the first week or two, then fade as your body adjusts. The most frequently reported include nausea, headache, trouble sleeping or excessive sleepiness, dry mouth, increased sweating, and sexual side effects like decreased libido or difficulty with orgasm. Sexual side effects are the ones most likely to persist.
One cardiac concern worth knowing about: Lexapro can cause a small, dose-dependent change in heart rhythm called QT prolongation. For the vast majority of people at standard doses, this is clinically insignificant. The risk becomes relevant mainly in people with existing heart conditions, electrolyte imbalances, liver impairment, or those taking other medications that also affect heart rhythm.
Stopping Lexapro Safely
Lexapro should not be stopped abruptly. Doing so can trigger discontinuation syndrome, a cluster of temporary but unpleasant symptoms. A useful way to remember them is the mnemonic FINISH: flu-like symptoms (fatigue, headache, sweating), insomnia with vivid dreams, nausea, imbalance or dizziness, sensory disturbances (electric shock-like sensations), and hyperarousal (irritability, agitation, anxiety).
Tapering gradually over six to eight weeks reduces this risk. If you’ve only been on the medication for less than four weeks, tapering may not be necessary. If discontinuation symptoms are severe, the standard approach is to restart the medication and taper more slowly. One important distinction: discontinuation symptoms usually appear within days and resolve quickly once the drug is reintroduced. If anxiety symptoms return gradually over weeks, that’s more likely a relapse of the underlying condition rather than withdrawal.
Pregnancy and Breastfeeding
Data from more than 15,000 pregnancies exposed to Lexapro or its close relative Celexa shows that most studies have not found an increased risk of birth defects or miscarriage. Some studies suggest a possible increase in preterm delivery or low birth weight when the medication is taken throughout pregnancy, though these risks are modest.
Babies exposed to SSRIs late in pregnancy can experience temporary symptoms after birth, including irritability, jitteriness, tremors, and changes in sleep or feeding patterns. These are self-limiting. A small number of studies have suggested a slightly higher risk of a serious newborn lung condition called persistent pulmonary hypertension, but even in those studies the rate was below 1%, compared to a baseline of roughly 1 to 2 per 1,000 births.
Lexapro does pass into breast milk in small amounts. Most studies have not found harmful effects or developmental differences in breastfed infants, though occasional cases of sleepiness and weight loss have been reported. For many people, the benefit of treating anxiety during pregnancy or postpartum outweighs these small risks, but this is a decision best made individually with a prescriber who knows your full history.