Lexapro (escitalopram) is a widely used selective serotonin reuptake inhibitor (SSRI). It is frequently prescribed for the long-term management of major depressive disorder and generalized anxiety disorder. While initial side effects often diminish, a specific set of physical, emotional, and systemic effects may persist or only become apparent after continuous use over many months or years. Understanding these long-term alterations is important for anyone undergoing extended treatment.
Persistent Physical Changes During Long-Term Use
Long-term use often involves sustained alterations in body weight. While some individuals experience initial weight loss, many long-term users report gaining weight, linked to shifts in appetite or metabolism. Studies suggest the average weight gain associated with Lexapro use is around 3.7% of initial body weight.
Sexual dysfunction is a highly prevalent and often persistent side effect, affecting an estimated 40% to 65% of individuals taking SSRIs. This typically manifests as decreased libido, difficulty achieving orgasm (anorgasmia), or delayed ejaculation. For a minority of users, these sexual side effects, including genital numbness, can persist after the medication is stopped, a condition known as Post-SSRI Sexual Dysfunction.
Other somatic effects may also endure throughout treatment. Chronic fatigue or persistent daytime sleepiness, while often intense initially, can remain a mild but consistent issue for some long-term users. Excessive sweating (hyperhidrosis) is another physical complaint that may not resolve over time and often requires management strategies.
Chronic Emotional and Cognitive Alterations
Long-term Lexapro use can cause emotional blunting or numbness. This involves a reduction in the intensity of both positive and negative emotions, leaving individuals feeling “flattened” or detached. Studies suggest this blunted emotional state occurs in approximately 40% to 65% of long-term users.
This emotional dulling can significantly impact quality of life and relationships, making it difficult to feel joy, sadness, or empathy deeply. Users often report feeling emotionally indifferent, which is distinct from the original depressive symptoms. This effect is considered a direct consequence of the drug’s mechanism on the central nervous system.
A related concern is the development of SSRI-induced apathy syndrome, characterized by a chronic lack of motivation and drive. This syndrome involves diminished initiation, poor persistence, and a loss of intellectual curiosity, separate from residual depression symptoms. The mechanism involves the drug’s effect on neurotransmitters that regulate reward and motivation.
Some long-term users also report persistent cognitive effects, commonly referred to as “brain fog.” Symptoms include difficulty concentrating on complex tasks, memory lapses, and general mental sluggishness. This reduced mental sharpness can interfere with professional and personal responsibilities.
Systemic Risks Requiring Ongoing Monitoring
Extended use of Lexapro is associated with risks to major physiological systems requiring periodic medical oversight. Chronic SSRI use has been linked to a reduction in bone mineral density. The drug may interfere with serotonin signaling, which regulates the cells responsible for building and breaking down bone tissue.
This mechanism increases the risk of fractures, particularly in older patients; some studies indicate a nearly doubled risk of hip fracture in adults over 50. Healthcare providers may recommend monitoring bone density, especially for patients with other risk factors for osteoporosis.
Lexapro also carries a risk for hyponatremia, a condition characterized by abnormally low sodium levels in the blood, relevant for the elderly population. This electrolyte imbalance is often caused by the Syndrome of Inappropriate Antidiuretic Hormone Secretion, where the body retains too much water, diluting the sodium. Symptoms like confusion, headache, unsteadiness, or weakness can be mistaken for other age-related issues.
A rare systemic risk is the potential for dose-dependent QT interval prolongation, an alteration in the heart’s electrical activity. This effect is a risk factor for a serious heart rhythm disturbance called torsades de pointes, leading the FDA to issue a warning regarding maximum dosing. While cardiac risk is low for most patients, those with pre-existing heart conditions or who are taking other QT-prolonging medications may require monitoring.
Understanding Lexapro Discontinuation Syndrome
Individuals considering long-term Lexapro use must be prepared for the process of eventually stopping the medication. Abruptly ceasing treatment can trigger Antidepressant Discontinuation Syndrome, a collection of uncomfortable physical and psychological symptoms. These symptoms result from the brain’s sudden adjustment to the drug’s absence, not a return of the original illness.
The most common signs include sensory disturbances known as “brain zaps”—brief, electric shock-like sensations—dizziness, nausea, and flu-like symptoms. Psychological symptoms like anxiety, irritability, and mood instability are also frequently reported. The severity and duration of these effects are highly variable, but they are often more pronounced in those who have taken the medication for a long time or at a high dosage.
To minimize the risk and severity of these symptoms, a gradual tapering process under medical supervision is mandatory. This involves slowly reducing the dosage over several weeks to months, allowing the brain time to safely recalibrate its serotonin levels. Stopping Lexapro “cold turkey” should be avoided.