Overview
Escitalopram is a selective serotonin reuptake inhibitor (SSRI) antidepressant used to treat major depressive disorder and generalized anxiety disorder. It works by increasing serotonin levels in the brain to improve mood and reduce anxiety symptoms.
Mechanism of Action
Escitalopram is a highly selective serotonin reuptake inhibitor (SSRI) that potently inhibits presynaptic serotonin reuptake with minimal effects on norepinephrine and dopamine reuptake. It has no significant affinity for serotonergic, adrenergic, dopaminergic, histaminergic, muscarinic, or benzodiazepine receptors.
Indications
- Major depressive disorder (MDD)
- Generalized anxiety disorder (GAD)
Common Doses
- 5 mg
- 10 mg
- 20 mg
Dosage
Initial dose typically 10 mg once daily, may be increased to 20 mg daily after at least one week. Maximum recommended dose is 20 mg daily.
Contraindications
- Concomitant use with monoamine oxidase inhibitors (MAOIs) or within 14 days of MAOI discontinuation
- Pimozide use due to risk of QT prolongation
- Known hypersensitivity to escitalopram or citalopram
Side Effects
- Nausea
- Insomnia
- Ejaculation disorder
- Fatigue
- Somnolence
- Increased sweating
- Decreased libido
- Anorgasmia
- Dry mouth
- Constipation
- Dizziness
- Increased appetite
- Weight gain
Interactions
- Monoamine oxidase inhibitors (MAOIs) - risk of serotonin syndrome
- Other serotonergic drugs (triptans, tramadol, lithium, St. John's wort)
- Drugs that prolong QT interval
- NSAIDs, aspirin, warfarin - increased bleeding risk
- CYP2C19 inhibitors (omeprazole, cimetidine) - may increase escitalopram levels
Counseling Points
- Take once daily with or without food
- Do not stop abruptly - taper under medical supervision
- Report any worsening depression, suicidal thoughts, or unusual behavior changes
- Allow several weeks for full therapeutic effect
- Avoid alcohol while taking this medication
- Report signs of serotonin syndrome (agitation, hallucinations, fever, sweating)