Lexapro (escitalopram) is a commonly prescribed antidepressant medication. It belongs to a class of antidepressants called selective serotonin reuptake inhibitors (SSRIs). Lexapro works by increasing levels of serotonin, a neurotransmitter that regulates mood, in the brain. It is approved by the FDA for treating major depressive disorder and generalized anxiety disorder in adults.
Lexapro is one of the most widely used antidepressants. In 2021, over 14 million prescriptions were written for escitalopram in the United States alone. Though generally well-tolerated, Lexapro does have potential side effects and can cause withdrawal symptoms when discontinued abruptly. This article will provide an in-depth overview of Lexapro, including its uses, benefits, side effects, and withdrawal process.
Lexapro enhances serotonin signaling in the brain by inhibiting the reuptake of serotonin. Here's a quick explanation of how it works :
Lexapro is FDA-approved to treat the following conditions :
It has also shown efficacy in clinical trials for:
The key benefits of Lexapro include:
Lexapro is generally well tolerated, but some potential side effects, especially when first starting treatment, include :
Some less common side-effects are:
Finally, some uncommon side-effects can present themselves:
Lexapro is not addictive but many long-term users do experience withdrawal symptoms when reducing dosage or stopping the medication. This occurs because the brain becomes dependent on the artificially elevated serotonin levels. When Lexapro is discontinued, serotonin drops and the brain must readjust. The resulting imbalance in neurotransmitters causes both physical and emotional withdrawal symptoms.
There are several situations that can precipitate Lexapro withdrawal:
Suddenly stopping Lexapro after extended use leads to a steep plunge in serotonin levels. This shock to the brain often triggers severe withdrawal. Doctors strongly advise gradually tapering dosage over a period of weeks or even months to avoid harsh side effects.
For example, someone taking 20mg/day for a year should gradually reduce by 5mg each week before fully stopping. This gradual decline in dosage gives the brain more time to rebalance neurotransmitters and adapt to functioning with less serotonin augmentation. Quitting Lexapro abruptly after long-term use almost always leads to difficult withdrawal.
If someone inadvertently forgets to take their regular Lexapro dose, withdrawal can start within hours because of the drop in serotonin. Symptoms generally resolve quickly once dosage is resumed. But multiple missed doses in a row substantially increase withdrawal severity.
This is because Lexapro has a short half-life - its concentration in the body drops by 50% every 24 hours. Just a few missed doses can leave someone with minimal Lexapro left in their system. This sends serotonin levels plummeting and triggers escalating withdrawal symptoms.
Doctors may incrementally reduce someone's Lexapro dosage over weeks or months to help safely transition off the medication. Even with this gradual tapering schedule, each dose decrement causes mild withdrawal effects as the brain adjusts to slightly lower serotonin levels.
Symptoms tend to emerge towards the end of the dosage interval as the last dose wears off. These minor withdrawal episodes after each dose reduction compile to increase overall withdrawal discomfort during the taper. This is unavoidable but reinforces the importance of gradual Lexapro cessation.
Starting or stopping a medication that interacts with Lexapro can disrupt serotonin balance and cause pseudo-withdrawal. For example, drugs like tramadol, linezolid, and methylene blue prevent Lexapro from working properly. This leads to falling serotonin levels and withdrawal symptoms even if the Lexapro dosage remains constant. Checking for medication and supplement interactions is important before and during Lexapro treatment.
Elements like genetics, metabolism, age, and medical conditions influence how dependent someone's neurochemistry becomes on Lexapro for proper serotonin signaling. These innate and acquired factors affect the brain's sensitivity and adaptability to dosage changes.
For instance, a mutation in the CYP2C19 liver enzyme that metabolizes Lexapro could lead to much higher blood levels for a given dose. If this person stops suddenly, their withdrawal may be more extreme due to the exaggerated imbalance. Older individuals and those with conditions like hypothyroidism that slow metabolism are also prone to more intense withdrawal effects.
In general, the longer someone takes therapeutic doses of Lexapro, the more ingrained the serotonin imbalance becomes. As a result, intense withdrawal symptoms upon discontinuation become increasingly likely.
Lexapro withdrawal can produce an array of uncomfortable symptoms, both physical and psychological. These usually start within a few days after stopping Lexapro but can emerge after just missing one dose.
Withdrawal normally lasts for 2-4 weeks but symptoms may persist at lower intensity for months in some cases, especially after long-term treatment. The severity and duration of symptoms depend on individual factors like dosage, length of treatment, physiology, and rate of taper.
These unpleasant withdrawal effects underscore why it is critical to wean off Lexapro slowly under medical supervision. Abruptly stopping puts someone at risk of debilitating physical and psychological symptoms. Doctors may prescribe interim medications like Prozac to smoothen the crossover and minimize the impact of withdrawal.
Lexapro withdrawal symptoms can sometimes be confused with a return of the original anxiety or depression. However, there are ways to distinguish between discontinuation effects versus true psychiatric relapse:
Relapse tends to occur gradually whereas discontinuation symptoms emerge within days of stopping Lexapro. Withdrawal starts quickly but improves steadily whereas relapse intensifies over time.
Restarting Lexapro will alleviate withdrawal but has little effect on returning psychiatric symptoms. Relapse often requires starting a different antidepressant medication.
While there is overlap, withdrawal is characterized more by physical symptoms like dizziness, headaches, and nausea, while relapse centers on sadness, suicidal thoughts, and lack of interest.
Withdrawal symptoms typically resolve within weeks whereas relapse persists indefinitely without treatment. Lingering symptoms beyond a month likely signify a genuine recurrence of anxiety or depression rather than mere withdrawal effects.
Distinguishing withdrawal from relapse ensures people get appropriate care. The discomfort of withdrawal wanes with time but recurring mental illness needs acute attention and modification of long-term treatment plans. Being attuned to the unique characteristics and trajectories of withdrawal versus relapse allows for optimal management when discontinuing Lexapro.
Lexapro withdrawal can be challenging to endure, but there are ways to ease the transition and get through this period safely under medical supervision. Understanding the general timeline of withdrawal and utilizing coping strategies allows people to minimize discomfort until serotonin levels normalize.
While variable between individuals, Lexapro withdrawal often follows a rough timeline after completely stopping the medication:
In the first few days, usually days 1-4, the first signs of withdrawal appear. These early symptoms tend to be milder and include flu-like achiness, insomnia, nausea, and sensory disturbances like tingling or electric shock sensations. While unpleasant, these initial symptoms are usually manageable with over-the-counter remedies and lifestyle adjustments.
Withdrawal typically intensifies in the second week, around days 5-7. This period often represents the peak of withdrawal severity. Depression, anxiety, crying spells, vertigo, and brain zaps are common during this time, along with continued flu-like symptoms and sleep disruption. Support and coping aids become crucial to endure the peak symptoms.
In the third and fourth week after stopping Lexapro, most physical symptoms resolve but psychological symptoms persist. Depression, mood swings, and difficulty concentrating prevail during this time. Energy starts to return but motivation may remain low and crying spells still occur. Ongoing support and redirection of thoughts is important.
Finally, by weeks 5-6, most symptoms are improving steadily. Psychological symptoms continue to abate, energy increases, and normal sleep returns for most people. However, brain zaps may still strike periodically and low-grade headaches, fatigue, and emotional sensitivity could linger. Anxiety about coping without the medication diminishes.
With very gradual dosage tapering under medical supervision, the timeline is more attenuated and protracted. But the week 2-3 mark remains the peak of withdrawal intensity before symptoms begin improving. Understanding the usual ebb and flow of withdrawal makes it more tolerable.
There are many constructive techniques to manage withdrawal discomfort:
Having an arsenal of coping tools makes withdrawal more bearable, especially getting through the peak severity period.
It is vital to work closely with a doctor when discontinuing Lexapro to:
Gradually tapering dosage over weeks or months under medical supervision substantially reduces the risks, severity and duration of withdrawal. This approach eases the neurochemical adaptations needed as serotonin declines. Doctors can provide encouragement and adjust the taper schedule if symptoms flare and become unmanageable.
Doctors can also prescribe supportive medications to ease particular withdrawal symptoms like insomnia, anxiety, or depression that emerge despite gradual tapering. Monitoring mental health and distinguishing withdrawal effects from psychiatric relapse is another key role for physicians. They may alter medications or treatment plans if it appears an underlying condition is resurfacing.
Good medical oversight also involves conducting important health screening during withdrawal like monitoring weight, blood pressure, and suicidal ideation. Emotional support and expert guidance on what to expect reduces uncertainty and anxiety during this transition.
Withdrawing from any psychiatric drug without medical supervision is extremely risky. Having your doctor's assistance through the ups and downs of withdrawal facilitates safe discontinuation. Be transparent with them about all symptoms so they can provide optimal management and reassurance.
In addition to traditional medical management, there are some other medications and therapeutic techniques that may help ease Lexapro withdrawal effects. These alternatives should be discussed with a doctor to determine appropriate options on a case-by-case basis.
Due to its exceptionally long half-life, Prozac remains active in the body much longer than shorter-acting SSRIs like Lexapro. Doctors may prescribe Prozac during withdrawal and slowly taper the dosage over months. This effectively bridges the gap, keeping serotonin levels more stable and avoiding steep drops during the crossover process. For maximum benefit, the switch to Prozac should occur while still taking Lexapro so their effects overlap. Typical dosage is 10-20mg daily for 4-6 months tapering.
This newer antidepressant modulates serotonin activity in a complex, nuanced manner rather than simply blocking reuptake. Switching to Trintellix avoids complete serotonin system depletion during Lexapro withdrawal. Trintellix is not an SSRI and has a lower incidence of discontinuation symptoms. Gradual cross-tapering Lexapro down as Trintellix is titrated up over several weeks can facilitate transitioning. The target dose is usually 10-20mg daily.
This non-habit forming anti-anxiety medication stimulates serotonin 1A receptors similarly to SSRIs, but without directly blocking serotonin reuptake. This may help manage anxiety, irritability, and insomnia during Lexapro withdrawal. Buspirone is typically dosed at 10-30mg divided into 2-3 daily doses. It takes about 2 weeks to take full effect.
Clonidine reduces adrenergic overdrive involved in withdrawal symptoms like agitation, panic attacks, and insomnia. It may be prescribed at low doses of 0.1-0.3 mg twice daily in the short-term to help alleviate these effects during peak withdrawal intensity.
Beta blockers like propranolol curb the autonomic arousal behind symptoms such as heart palpitations and tremor. Beta blockers do not alter neurotransmitter systems long-term but can provide temporary relief of hyperadrenergic symptoms. Doses around 10-40mg twice daily may be used symptomatically during withdrawal.
Fish oil and other omega-3 supplements help replenish membranes that are depleted by long-term SSRI usage. This structural support aids withdrawal. High doses up to 2 grams of combined EPA/DHA daily may be helpful.
Magnesium supplementation can ease muscle cramps, tension, anxiety, insomnia and irritability - common Lexapro withdrawal complaints. Doses of 400-600 mg daily in divided doses, preferably as chelated formulations for better absorption, may provide relief.
This amino acid is the precursor for serotonin synthesis in the body and brain. L-tryptophan at doses of 500-2000 mg twice daily may soften the serotonin plunge during Lexapro withdrawal. It may also improve sleep.
Probiotic supplements support healthy gut microbiota which influence neurotransmitter balance through the gut-brain axis. This stabilizing effect could benefit Lexapro withdrawal. Doses around 20-50 billion CFUs from reputable brands taken daily may be helpful.
Timeline of withdrawal: