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Lexapro (Escitalopram) for Anxiety, Social Phobia, Depression

Lexapro for Anxiety Disorders

Escitalopram has anxiolytic properties and is beneficial for treating various anxiety disorders, including generalised anxiety disorder (GAD), social anxiety (social phobia), panic disorder 10, and obsessive-compulsive disorder (OCD).

Escitalopram lessens stress and anxiety level; takes off depressive thoughts and worry. It helps to better handle the life situations and to be more motivated to accomplish daily activities. Escitalopram significantly reduces fear of blushing in persons with social anxiety11.

Many psychiatrists consider that escitalopram is the best SSRI for GAD and social anxiety. It may help to cope with resistant social anxiety.

Among nine treatments for generalised anxiety disorder escitalopram was rated second in remission 3.

Long-term escitalopram therapy may prevent relapse in GAD4 for up to 18 months. In the study the risk of relapse was four times higher in the placebo group compared to the escitalopram group. That's a key answer on the question: "How long should you take this? What will happen if you stop antidepressant?" Well the answer is, your risk of relapse is four times higher.

Escitalopram vs Paroxetine in GAD

Escitalopram was found to be superior to paroxetine with respect to overall efficacy and tolerability5. What was interesting is that escitalopram 10 mg was more effective than paroxetine 20 mg.

Also, escitalopram offers a more cost-effective first-line treatment for GAD compared with paroxetine6.

Dosage for anxiety disorders: The recommended dose of escitalopram in generalised anxiety disorder and social anxiety is 10 mg daily, increasing to a maximum of 20 mg daily.

Lexapro for Depression

Escitalopram is suitable as a first-line treatment for moderate to severe major depressive disorder. It is often more effective than citalopram and other SSRIs in the treatment of depression, including severe depression1.

Escitalopram is the most selective of all the SSRIs, having little or negligible affinity for numerous other receptors. It binds to the serotonin transport molecule and boosts the concentration of serotonin in the synapse.

Dosage for depression: Initially, 10 mg once daily; dose may be increased as tolerated to a maximum of 20 mg once daily.

How long does Lexapro take to work?

Depression
Escitalopram works fairly rapidly and tends to work faster than other SSRIs2. You may expect improvement beginning in 1-2 weeks, although the full effect may take 4 to 6 weeks8.

Anxiety disorders
Most people start feeling improvement by week 2. Escitalopram can take up to 8 weeks to reach full anti-anxiety effect9.

Generally, when Lexapro is used for the treatment of depression, GAD, or social anxiety, a period of at least 4 weeks is worthwhile before considering whether to continue to take it or choosing other options7. Sometimes, up to 8 weeks are required to reach full effectiveness.

How long to stay on Lexapro?

The duration of treatment depends on the personal psychiatric history, but is usually at least 6 months. It will be longer for those who have had two or more previous episodes of depression. Once your depression is gone you may continue escitalopram for up to 6-12 months.

How to come off Lexapro?

The withdrawal results in fewer and less intense discontinuation symptoms than from either paroxetine or venlafaxine.

Don't discontinue escitalopram abruptly. Abrupt cessation may result in withdrawal symptoms such as confusion, lethargy, insomnia, tingling or shock like sensations. Onset of these symptoms usually occurs within a week of discontinuation and may last from a few days to several weeks.

Reducing dose by 10-25% every 2 weeks would be a sensible attempt to come off. More gradual steps allow more time for the brain to adapt to the decreasing levels of escitalopram. Keep in mind that Lexapro is available in liquid form which allows you to taper off at a very gradual pace.

See also

References

  • 1. Kennedy SH, Andersen HF, Lam RW. Efficacy of escitalopram in the treatment of major depressive disorder compared with conventional selective serotonin reuptake inhibitors and venlafaxine: a meta-analysis. J Psychiatry Neurosci. 2006 Mar;31(2):122-31. PubMed
  • 2. Kasper S, Spadone C, Verpillat P, Angst J. Onset of action of escitalopram compared with other antidepressants: results of a pooled analysis. Int Clin Psychopharmacol. 2006 Mar;21(2):105-10. PubMed
  • 3. Baldwin D, Woods R, Lawson R, Taylor D. BMJ. 2011 Mar 11;342:d1199
  • 4. Allgulander C, Florea I, Huusom AK. Prevention of relapse in generalized anxiety disorder by escitalopram treatment. Int J Neuropsychopharmacol. 2006 Oct;9(5):495-505.
  • 5. Baldwin DS, Huusom AK, Maehlum E. Escitalopram and paroxetine in the treatment of generalised anxiety disorder: randomised, placebo-controlled, double-blind study. Br J Psychiatry. 2006 Sep;189:264-72. PubMed
  • 6. Iskedjian M, Walker JH, Bereza BG, Le Melledo JM, Einarson TR. Cost-effectiveness of escitalopram for generalized anxiety disorder in Canada. Curr Med Res Opin. 2008 May;24(5):1539-48.
  • 7. Baldwin DS, Stein DJ, Dolberg OT, Bandelow B. How long should a trial of escitalopram treatment be in patients with major depressive disorder, generalised anxiety disorder or social anxiety disorder? Hum Psychopharmacol. 2009 Jun;24(4):269-75. PubMed
  • 8. Kasper S, Spadone C, Verpillat P, Angst J. Onset of action of escitalopram compared with other antidepressants. Int Clin Psychopharmacol. 2006 Mar;21(2):105-10 PubMed
  • 9. Goodman WK, Bose A, Wang Q. Treatment of generalized anxiety disorder with escitalopram. J Affect Disord. 2005 Aug;87(2-3):161-7.
  • 10. Choi KW, Woo JM, Kim YR, Lee SH, Lee SY, Kim EJ, Chung SK, Kang EH, Lee JH, Yu BH. Long-term Escitalopram Treatment in Korean Patients with Panic Disorder: A Prospective, Naturalistic, Open-label, Multicenter Trial. Clin Psychopharmacol Neurosci. 2012 Apr;10(1):44-8. PubMed
  • 11. Pelissolo A, Moukheiber A. Open-label treatment with escitalopram in patients with social anxiety disorder and fear of blushing. J Clin Psychopharmacol. 2013 Oct;33(5):695-8. PubMed

Author: OriginalDrugs Team
Last reviewed: February, 2015

Quick facts
Lexapro

  • In December 2003 escitalopram received FDA approval for the treatment of Generalized Anxiety Disorder.