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Selective Serotonin Reuptake Inhibitor (SSRI)

Escitalopram | Lexapro

Clinical Overview

Escitalopram is a selective serotonin reuptake inhibitor (SSRI) indicated for major depressive disorder and generalized anxiety disorder. It is the S-enantiomer of citalopram and demonstrates high selectivity for the serotonin transporter with minimal effects on other neurotransmitter systems.

Primary Clinical Applications

Escitalopram is effective for major depressive disorder in adults and adolescents (12+ years) and generalized anxiety disorder in adults. It is often considered first-line treatment due to its favorable efficacy and tolerability profile, with lower drug interaction potential compared to many other antidepressants.

Mechanism and Clinical Benefits

Escitalopram selectively inhibits the serotonin transporter (SERT) with high affinity and selectivity. It has minimal affinity for other receptors, resulting in fewer side effects. The medication demonstrates linear pharmacokinetics and reaches steady-state levels within one week of dosing.

Clinical Advantages

Escitalopram has a favorable side effect profile with relatively low rates of sexual dysfunction, weight gain, and drug interactions compared to other antidepressants. It can be taken with or without food and has predictable dosing across most patient populations.

Prescribing Information

Dosing & Administration

Major Depressive Disorder – Adults:

  • Initial: 10 mg once daily
  • Range: 10-20 mg once daily
  • Maximum: 20 mg once daily

Major Depressive Disorder – Adolescents (12-17 years):

  • Initial: 10 mg once daily
  • Range: 10-20 mg once daily
  • Maximum: 20 mg once daily

Generalized Anxiety Disorder – Adults:

  • Initial: 10 mg once daily
  • Range: 10-20 mg once daily
  • Maximum: 20 mg once daily

Elderly (≥65 years):

  • Recommended dose: 10 mg once daily

Administration:

  • Take once daily, morning or evening
  • With or without food
  • Same time each day for consistency

Indications

  • Major depressive disorder (adults and adolescents ≥12 years)
  • Generalized anxiety disorder (adults)

Contraindications

  • Hypersensitivity to escitalopram or citalopram
  • Use with MAOIs (within 14 days)
  • Use with pimozide
  • Use with linezolid or IV methylene blue

Warnings & Precautions

  • Boxed Warning: Increased risk of suicidal thoughts and behavior in patients under 25 years
  • Serotonin syndrome: Risk with concurrent serotonergic drugs
  • QT prolongation: Dose-dependent risk, monitor in predisposed patients
  • Activation of mania: Monitor in patients with bipolar disorder
  • Discontinuation syndrome: Taper gradually when stopping
  • Hyponatremia: Particularly in elderly patients

Drug Interactions

  • MAOIs: Contraindicated – minimum 14-day washout
  • Pimozide: Contraindicated – QT prolongation risk
  • Serotonergic drugs: Increased serotonin syndrome risk
  • Anticoagulants: Increased bleeding risk
  • CYP2C19 inhibitors: May increase escitalopram levels

Adverse Reactions

Common (≥5%):

  • Nausea, insomnia, ejaculation disorder, somnolence
  • Sweating increased, fatigue, decreased appetite

Less Common:

  • Sexual dysfunction, weight changes, dizziness

Special Populations

  • Hepatic Impairment: 10 mg once daily (maximum dose)
  • Renal Impairment: No dose adjustment needed for mild-moderate impairment
  • Elderly: 10 mg once daily recommended
  • Pregnancy: Category C – use only if benefits outweigh risks
  • QT Risk: Maximum 20 mg daily due to dose-dependent QT prolongation
Medical Disclaimer: This information is for educational purposes only and is not intended as medical advice. Always consult with qualified healthcare professionals before making any treatment decisions. Individual patient circumstances may vary significantly.