Escitalopram

NHS Choices

About escitalopram

Escitalopram is a type of antidepressant known as an SSRI (selective serotonin reuptake inhibitor).

It is often used to treat depression and is sometimes used for anxiety, obsessive compulsive disorder or panic attacks.

Escitalopram helps many people recover from depression, and it has fewer unwanted effects than older antidepressants.

Escitalopram is available on prescription. It comes as tablets and as liquid drops that you put in a drink.

Key facts

It usually takes 4 to 6 weeks for escitalopram to work.
Side effects such as nausea and headache are common. They are usually mild and go away after a couple of weeks.
Escitalopram can affect an unborn baby. Tell your doctor straight away if you’re trying to get pregnant or become pregnant while taking it.
Escitalopram can cause withdrawal symptoms so don't stop taking it without talking to your doctor.
Escitalopram is called by the brand name Cipralex.

Who can and can't take escitalopram

Escitalopram can be taken by adults over the age of 18.

Escitalopram isn't suitable for some people. Check with your doctor before starting to take escitalopram if you:

have had an allergic reaction to escitalopram or any other medicines in the past
have epilepsy - as escitalopram can increase your seizures
have a heart problem - as escitalopram can speed up or change your heartbeat
have a low heart rate plus you have had severe diarrhoea and vomiting for a long time or take water tablets
have liver or kidney problems - your doctor may need to change your dose
have been told you have low sodium (salt) levels
bruise or bleed easily
are having electroconvulsive treatment
have ever taken any other medicines for depression - some rarely used antidepressants can interact with escitalopram to cause very high blood pressure even when they've been stopped for a few weeks
are trying to become pregnant, are already pregnant or are breastfeeding - escitalopram is not usually recommended in pregnancy or while breastfeeding
have an eye problem called glaucoma because escitalopram can increase the pressure in your eye

If you have diabetes, escitalopram can make it more difficult to keep your blood sugar stable. Monitor your blood sugar more often for the first few weeks of treatment with escitalopram and adjust your diabetes treatment if necessary.

How and when to take it

Take escitalopram once a day. You can take it with or without food.

You can take escitalopram at any time of day, as long as you stick to the same time every day. If you have trouble sleeping, it's best to take it in the morning.

How much will I take?

Escitalopram tablets come in different strengths ranging from 5mg to 20mg.

The usual dose of escitalopram is 10mg a day in adults. However, you may start on a lower dose and increase to a maximum dose of 20mg a day. If you have liver problems, the maximum recommended dose is 10mg a day.

With liquid drops of escitalopram, 1 drop is equivalent to 1mg, 10 drops is 10mg, 20 drops is 20mg.

What if I forget to take it?

Do not take a double dose to make up for forgotten doses. If you do forget to take a dose, and you remember before you go to bed, take it straight away. Carry on as usual the next day. If you only remember during the night, or the next day, leave out the missed dose and carry on as usual.

If you forget doses often, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

What if I take too much?

Ask your doctor for advice straight away. An overdose can lead to potentially serious symptoms such as:

agitation
being sick (vomiting)
shaking
fast heart rate
seizures

Side effects

Like all medicines, escitalopram can cause side effects in some people, but many people have no side effects or only minor ones. Some of the common side effects of escitalopram will gradually improve as your body gets used to it.

Common side effects

Common side effects may happen in more than 1 in 10 people. Keep taking the medicine but talk to your doctor or pharmacist if these side effects bother you or don't go away:

dry mouth
sweating a lot
being unable to sleep
feeling sleepy
feeling tired or weak

Serious side effects

Serious side effects are rare and happen in less than 1 in 1,000 people. Tell a doctor straight away if you get:

headache, trouble focusing, memory problems, not thinking clearly, weakness, seizures or losing your balance - these can be signs of low sodium levels
thoughts about harming yourself or ending your life
a high temperature (above 38C) with agitation, confusion, trembling and twitching
severe dizziness or passing out
weight gain or loss without trying to
changes in your periods such as heavy bleeding, spotting or bleeding between periods
painful erections that last longer than 4 hours - this may happen even when you are not having sex

Or, if you develop any signs of abnormal bleeding including:

vomiting blood or dark vomit, coughing up blood, blood in your pee, black or red poo - these can be signs of bleeding from the gut
bleeding from the gums or bruises that appear without a reason or that get bigger
any bleeding that is very bad or that you cannot stop

Serious allergic reaction

In rare cases, it’s possible to have a serious allergic reaction to escitalopram.

A serious allergic reaction is an emergency. Contact a doctor straight away if you think you or someone around you is having a serious allergic reaction.

The warning signs of a serious allergic reaction are:

getting a skin rash that may include itchy, red, swollen, blistered or peeling skin
wheezing
tightness in the chest or throat
having trouble breathing or talking
swelling of the mouth, face, lips, tongue, or throat

These are not all the side effects of escitalopram. For a full list see the leaflet inside your medicines packet.

You can report any suspected side effect to the UK safety scheme.

How to cope with side effects

What to do about:

feeling sleepy - cut down the amount of alcohol you drink
dry mouth - chew sugar-free gum or sugar-free sweets
being unable to sleep - take escitalopram first thing in the morning

Except for problems getting to sleep, you can reduce the chance of having a side effect that bothers you if you take escitalopram in the evening. That way you're asleep when the level of medicine in your body is highest.

Pregnancy and breastfeeding

Escitalopram is generally not recommended in pregnancy or while breastfeeding.

No medicines for depression are considered completely safe to take in pregnancy or while breastfeeding. Your doctor will want to prescribe escitalopram when the benefits of you taking the medicine outweigh the risks.

Escitalopram and similar antidepressants have been linked with a small risk of problems for the unborn baby if you take them in late pregnancy.

Escitalopram and breastfeeding

Escitalopram passes into breast milk and has been linked with side effects, including withdrawal symptoms, in breastfed babies.

Tell your doctor if you're trying to get pregnant, are already pregnant or if you're breastfeeding.

Cautions with other medicines

Some medicines and escitalopram can interfere with each other and increase the chances of you having side effects.

Tell your doctor if you're taking these medicines before you start escitalopram:

any medicines that affect your heartbeat - as escitalopram can speed up or change your heartbeat
any other medicines for depression - some rarely used antidepressants can interact with escitalopram to cause very high blood pressure even when they have been stopped for a few weeks

These are not all the medicines that can interfere with escitalopram. For a full list see the leaflet inside your medicine packet or check with your pharmacist.

Mixing escitalopram with herbal remedies and supplements

Don't take St John's wort, the herbal remedy for depression, while you are being treated with escitalopram as this will increase your risk of side effects.

Tell your doctor or pharmacist if you're taking any other medicines, including herbal remedies, vitamins or supplements.

Common questions

How does escitalopram work?

Escitalopram is one of a group of antidepressants called selective serotonin reuptake inhibitors, or SSRIs. These medicines are thought to work by increasing the levels of a mood-enhancing chemical, called serotonin, in the brain.

When will I feel better?

You may not notice much improvement in your symptoms for a week or 2 until escitalopram begins to take effect. It usually takes between 4 and 6 weeks before you feel the full benefits.

Don't stop taking escitalopram after a week or two just because you feel it is not helping your symptoms. Give the medicine at least 6 weeks to work.

How will it make me feel?

Antidepressants like escitalopram help to jump start your mood so you feel better. You may notice that you sleep better and get on with people more easily because you're less anxious. You will hopefully take little things that used to worry you in your stride.

Escitalopram won't change your personality or make you feel euphorically happy. It will simply help you feel like yourself again.

Don't expect to feel better overnight though. Some people feel worse during the first few weeks of treatment before they begin to feel better.

How long will I take it for?

Once you're feeling better it's likely that you will continue to take escitalopram for several more months to prevent the symptoms returning.

You'll need to discuss with your doctor the pros and cons of continuing to take escitalopram for longer than a few months. The decision will depend on the type and severity of your symptoms, whether it's a one-off problem or one that keeps coming back, how well escitalopram works for you and whether you have had any bad side effects.

What will happen when I stop taking it?

Some people get side effects when they stop taking escitalopram, especially if they stop taking it suddenly.

To help prevent this, your doctor might recommend reducing your dose of escitalopram gradually over several weeks.

Don't stop taking escitalopram, suddenly, or without talking to your doctor.

Is it safe to take it for a long time?

Escitalopram is safe to take for a long time. There don’t seem to be any lasting harmful effects from taking it for many months and years.

Is escitalopram better than other antidepressants?

Escitalopram isn't any better or worse than other antidepressants. However, sometimes people respond better to one antidepressant than to another. Talk to your doctor if you aren't feeling any better after 6 weeks.

What is the difference between escitalopram and citalopram?

Escitalopram and citalopram are both medicines used to treat depression. They may sound similar but they're different medicines.

Differences include:

escitalopram doses are half that of citalopram
the type and frequency of side effects you may get are different with each medicine
escitalopram can be used for a wider range of health problems than citalopram

Will I gain or lose weight?

Escitalopram can make you feel less hungry, so you may lose weight when you first start taking it.

Later on, you may gain a little weight as your appetite returns.

If you start to have problems with your weight while taking escitalopram, talk to your doctor or pharmacist.

Can I drive or ride a bike?

Some people find they can't concentrate properly while they're taking escitalopram. It might be best to stop driving and cycling for the first few days of treatment until you know how this medicine makes you feel.

Will it affect my contraception?

For women, escitalopram will not affect contraceptive pills or the morning after pill.

Will it affect my sex life?

The good effects of escitalopram may, after a while, improve your sex life as your mood lifts and you become interested in life and relationships again.

Some of the possible negative effects include:

men getting painful erections, problems with getting an erection and problems with ejaculating
women having some vaginal bleeding and might not reach orgasm the same way as before
a lower sex drive

Sexual side effects should pass after the first couple of weeks. If they don't, and this is a problem for you, go back to your doctor to see if there's another antidepressant you can try.

Can I drink alcohol with it?

You can drink alcohol while taking escitalopram but it may make you feel sleepy. It might be best to stop drinking alcohol until you see how the medicine makes you feel.

Will recreational drugs affect it?

The sleep-inducing effects of cannabis can add to those of escitalopram, especially in people who have just started taking it. Cannabis with escitalopram can also give you a fast heartbeat.

Methadone can increase the risk of side effects in people taking escitalopram.

It can be potentially dangerous to take escitalopram with:

stimulants like MDMA (ecstasy) or cocaine
hallucinogens like LSD
novel psychoactive substances (which used to be known as legal highs) like mephedrone

Escitalopram hasn't been properly tested with recreational drugs. Talk to your doctor if you think you might use recreational drugs while taking escitalopram.

Is there any food or drink I need to avoid?

You can eat and drink normally while taking escitalopram.

Are there other treatments that will help?

Antidepressants, including escitalopram, are just one of several approaches to treating depression. Other potential treatments include:

talking therapy (such as cognitive behavioural therapy)
exercise programmes
help to get a good night's sleep

Choosing a treatment that's most suitable for you depends on how long you have had depression, your symptoms, whether you have had any previous bouts of depression, whether previous treatment has worked, how likely you are to stick with your treatment, the potential side effects and your preferences and priorities.