Lexapro (escitalopram) is a prescription antidepressant used primarily to treat major depressive disorder and generalized anxiety disorder. It belongs to a class of medications called SSRIs, which work by increasing the availability of serotonin in the brain, a chemical messenger that helps regulate mood, sleep, and emotional responses. It’s one of the most commonly prescribed antidepressants in the United States and is available as a tablet, capsule, or oral solution.
FDA-Approved Uses
Lexapro has two official, FDA-approved uses. The first is major depressive disorder (MDD) in adults under 65 and in adolescents 12 and older. The second is generalized anxiety disorder (GAD) in adults under 65. For GAD specifically, pediatric approval extends to children as young as 7.
Major depressive disorder goes beyond ordinary sadness. It involves persistent low mood, loss of interest in activities, changes in sleep and appetite, difficulty concentrating, and sometimes feelings of worthlessness that last at least two weeks and interfere with daily life. Generalized anxiety disorder, on the other hand, is characterized by excessive, hard-to-control worry about everyday matters that persists for six months or more, often accompanied by muscle tension, restlessness, and trouble sleeping.
Off-Label Uses
Doctors sometimes prescribe Lexapro for conditions beyond its two approved uses. Because SSRIs as a class affect serotonin pathways involved in a range of mental health conditions, prescribers may use it for social anxiety disorder, panic disorder, obsessive-compulsive disorder, or premenstrual mood symptoms. Open-label studies have also found that escitalopram, along with related SSRIs, improved body dysmorphic disorder in more than half of participants when combined with cognitive behavioral therapy. Off-label prescribing is common and legal, but the supporting evidence varies in strength depending on the condition.
How Lexapro Is Taken
The standard starting dose for both depression and anxiety is 10 mg once daily, taken with or without food. If that dose isn’t providing enough relief after at least one week (for adults), a prescriber may increase it to a maximum of 20 mg per day. For adolescents being treated for depression, the waiting period before a dose increase is longer: at least three weeks. For children 7 and older being treated for anxiety, the minimum interval is two weeks.
Lexapro is typically taken in the morning, though some people take it at night if it causes drowsiness. Consistency matters more than timing. Taking it at the same time each day keeps blood levels steady.
How Long It Takes to Work
Lexapro doesn’t work immediately. Some early improvements in sleep, energy, and appetite can appear within the first one to two weeks, which is encouraging but not the full picture. On average, it takes four to six weeks to feel the medication’s full therapeutic effect on mood and anxiety. This delay is one of the most frustrating aspects of antidepressant treatment, and it’s important to stick with the medication through those early weeks rather than assuming it isn’t working.
Common Side Effects
Most side effects are mild and tend to be strongest in the first week or two before tapering off. In real-world studies of SSRI users, the most frequently reported issues included drowsiness (59%), fatigue (45%), dry mouth (45%), weight gain (45%), and excessive yawning (47%). Compared to other SSRIs, escitalopram users reported somewhat higher rates of headache and dizziness.
Sexual side effects are also common across the SSRI class, including reduced libido and difficulty reaching orgasm. These don’t always go away on their own and are a frequent reason people ask to switch medications. Nausea is another early side effect that usually fades within the first couple of weeks.
How Lexapro Compares to Celexa
Lexapro is the refined version of an older drug called Celexa (citalopram). Celexa contains two mirror-image molecules, while Lexapro contains only the one believed to be active. In practice, 10 mg of Lexapro is pharmacologically equivalent to 20 mg of Celexa. Sixteen clinical trials involving nearly 3,800 adults compared the two for depression, and none found a difference in effectiveness that crossed the threshold for being clinically meaningful. Side effect rates were also similar between the two drugs. One modest difference: the FDA reported that Celexa at equivalent doses affects heart rhythm (QT prolongation) slightly more than Lexapro, though not at a level considered clinically significant at recommended doses.
Pregnancy and Breastfeeding
Escitalopram can be taken during pregnancy. A small number of studies have suggested a possible link to heart development changes in babies, but if any risk exists, it appears to be small, and the majority of babies born to women taking the medication have normal hearts. When taken in the final weeks of pregnancy, there is a small chance the newborn may experience short-term withdrawal symptoms or, very rarely, breathing difficulties. There may also be a slightly increased risk of postpartum bleeding, though this is rare and treatable.
The medication does pass into breast milk in small amounts. It doesn’t usually cause problems, but a few breastfed babies have shown irritability or restlessness. For many women, the benefit of staying on an effective antidepressant outweighs these small risks, and the decision is best made with a prescriber who knows your full history.
Stopping Lexapro Safely
Lexapro carries a moderate risk of discontinuation syndrome if stopped abruptly. Symptoms typically begin within two to four days and can include dizziness, nausea, flu-like achiness, vivid dreams, and electric shock-like sensations sometimes called “brain zaps.” Mood changes like irritability and increased anxiety are also common.
The fix is straightforward: resuming the previous dose usually resolves symptoms within 24 hours. From there, the standard approach is a slow, gradual taper under medical guidance. There’s no universal tapering schedule because it depends on how long you’ve been taking the medication, your dose, and your individual sensitivity. Some people taper over a few weeks, while others need several months. Stopping Lexapro is not something to do on your own.
Suicidal Thoughts in Young People
Like all antidepressants, Lexapro carries an FDA boxed warning about an increased risk of suicidal thoughts and behavior in children, adolescents, and young adults under 25. This risk is highest in the early weeks of treatment or when the dose changes. It does not mean the medication causes suicide. It means young people starting or adjusting antidepressant treatment need close monitoring, especially during the first few months. The risk of untreated depression is also serious, which is why the medication remains approved for adolescents 12 and older despite this warning.