1. About escitalopram
Escitalopram is a type of antidepressant known as a selective serotonin reuptake inhibitor (SSRI).
Escitalopram helps many people recover from depression and has fewer unwanted effects than older antidepressants.
Escitalopram is available on prescription. It comes as tablets and liquid drops that you put in a drink.
2. Key facts
- It usually takes 4 to 6 weeks for escitalopram to work.
- Side effects such as feeling sick (nausea) and headache are common. They're usually mild and go away after a couple of weeks.
- If you and your doctor decide to take you off escitalopram, your doctor will probably recommend reducing your dose gradually to help prevent extra side effects.
- Escitalopram is also called by the brand name Cipralex.
3. Who can and cannot take escitalopram
Escitalopram can be taken by adults over the age of 18.
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 or are having electroconvulsive treatment - escitalopram may increase your risk of having a seizure
- have a heart problem - 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 tablets that make you pee more (diuretics)
- 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 have been stopped for a few weeks
- are trying to become pregnant, already pregnant or breastfeeding
- have an eye problem called glaucoma - 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.
4. 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 to take
Escitalopram tablets come in different strengths ranging from 5mg to 20mg.
The usual dose of escitalopram is 10mg a day in adults. But 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 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?
The amount of escitalopram that can lead to an overdose varies from person to person.
Urgent advice: Call your doctor straight away if:
You have taken too much escitalopram by accident and experience symptoms such as:
- feeling agitated
- being sick (vomiting)
- a fast heart rate
If you need to go to A&E, do not drive yourself. Get someone else to drive you or call for an ambulance.
Take the escitalopram packet or the leaflet inside it, plus any remaining medicine, with you.
5. 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 a doctor or pharmacist if these side effects bother you or don't go away:
- a 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.
Go to A&E immediately if you get:
- painful erections that last longer than 4 hours - this may happen even when you're not having sex
- severe dizziness or passing out
- any bleeding that's very bad or you can't stop, such as cuts or nosebleeds that don't stop within 10 minutes
Call a doctor straight away if you get:
- constant headaches, long-lasting confusion or weakness, or frequent muscle cramps - these can all be signs of low sodium levels in your blood (in severe cases, low sodium can lead to seizures)
- thoughts about harming yourself or ending your life
- a high temperature (38C and above) with agitation, confusion, trembling and twitching
- vomiting blood, coughing up vomit, 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 get bigger
Book an appointment with your doctor if you experience:
- weight gain or loss without trying
- changes in your periods, such as heavy bleeding, spotting or bleeding between periods
Serious allergic reaction
In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to escitalopram.
Immediate action required: Call 999 or go to A&E now if:
- you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
- you're wheezing
- you get tightness in the chest or throat
- you have trouble breathing or talking
- your mouth, face, lips, tongue or throat start swelling
You could be having a serious allergic reaction and may need immediate treatment in hospital.
These aren't all the side effects of escitalopram.
For a full list, see the leaflet inside your medicines packet.
You can report any suspected side effect using the Yellow Card safety scheme.
6. How to cope with side effects
What to do about:
- a dry mouth - chew sugar-free gum or sugar-free sweets
- sweating a lot - try wearing loose clothing, using a strong anti-perspirant, and keeping cool using a fan, if possible. If this doesn't control the problem, talk to your doctor. You may need to try a different antidepressant.
- being unable to sleep - take escitalopram first thing in the morning
- feeling sleepy- take escitalopram in the evening and cut down the amount of alcohol you drink. Do not drive or use tools or machinery if you're feeling sleepy. If this doesn't help, talk to your doctor.
- feeling tired or weak - stop what you're doing and sit or lie down until you feel better. Do not drive or use tools or machinery if you're feeling tired. Do not drink alcohol as it'll make you feel worse.
7. Pregnancy and breastfeeding
Escitalopram in pregnancy
It's important for you and your baby that you stay well during your pregnancy.
If you become pregnant while taking escitalopram, speak to your doctor. Do not stop taking your medicine unless your doctor tells you to.
Escitalopram has been linked to a very small increased risk of problems for your unborn baby.
But if your depression isn't treated during pregnancy, this can also increase the chance of problems.
You may need to take escitalopram during pregnancy if you need it to remain well.
Your doctor can explain the risks and the benefits, and will help you decide which treatment is best for you and your baby.
For more information about how escitalopram can affect you and your baby during pregnancy, read this leaflet on the best use of medicines in pregnancy (BUMPs) website.
Escitalopram and breastfeeding
If your doctor or health visitor says your baby is healthy, escitalopram can be used during breastfeeding.
Escitalopram passes into breast milk in small amounts, and has been linked with side effects in very few breastfed babies.
It's important to continue taking escitalopram to keep you well. Breastfeeding will also benefit both you and your baby.
If you notice that your baby isn't feeding as well as usual, seems unusually sleepy or you have any other concerns about your baby, talk to your health visitor or doctor as soon as possible.
Non-urgent advice: Tell your doctor if you're:
- trying to get pregnant
8. 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 - 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 aren't 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
Do not take St John's wort, the herbal remedy for depression, while you're being treated with escitalopram as this will increase your risk of side effects.
Important: Medicine safety
Tell your doctor or pharmacist if you're taking any other medicines, including herbal medicines, vitamins or supplements.
9. 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 two until escitalopram begins to take effect.
It usually takes between 4 and 6 weeks before you feel the full benefits.
Do not stop taking escitalopram after a week or two just because you feel it's 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'll 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'll 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.
How do I come off escitalopram?
If you have been feeling better for 6 months or more, your doctor may suggest coming off escitalopram.
Your doctor will probably recommend reducing your dose gradually over several weeks, or longer if you have been taking escitalopram for a long time.
This is to help prevent any extra side effects you might get as a reaction to coming off the medicine.
- feeling sick
- numbness or tingling in the hands or feet
- trouble sleeping
- feeling agitated or anxious
Do not stop taking escitalopram suddenly or without talking to your doctor first.
Is it safe to take it for a long time?
For most people, escitalopram is safe to take for a long time.
A few people may get sexual side effects, such as problems getting an erection or a lower sex drive. In some cases these can continue even after stopping the medicine. Speak to your doctor if you are worried.
Otherwise there don’t seem to be any lasting harmful effects from taking escitalopram for many months or years.
Is escitalopram better than other antidepressants?
Escitalopram isn't any better or worse than other antidepressants.
But 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's 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.
- 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 fertility?
There's some evidence that escitalopram can reduce the quality of sperm, but it's not known whether this reduces male fertility.
The effect should reverse once you stop taking the medicine. Speak to your doctor if you're concerned.
For women, there's no firm evidence to suggest that taking escitalopram will reduce your fertility.
But speak to a pharmacist or doctor if you're trying to get pregnant. They may want to review your treatment.
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 having painful erections and problems getting an erection and ejaculating
- women having some vaginal bleeding and might not reach orgasm the same way as before
- a lower sex drive
Sexual side effects usually pass after the first couple of weeks. However, very rarely, they can be long lasting and may not get better even after stopping the medicine.
If these happen and are a problem for you, go back to your doctor to see if there's another treatment 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.
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 or anxiety.
Other potential treatments for depression include:
- talking therapy (such as cognitive behavioural therapy)
- exercise programmes
- help to get a good night's rest if sleep is a problem
Other potential treatments for anxiety include:
- talking therapy (such as cognitive behavioural therapy)
- joining a self-help group
- using relaxation techniques
Choosing a treatment that's most suitable for you depends on:
- how long you have had depression or anxiety
- your symptoms
- whether previous treatment has worked
- how likely you are to stick with your treatment
- the potential side effects
- your preferences and priorities
If you're interested in any of these treatments, talk to your doctor.
Will recreational drugs affect it?
Cannabis with escitalopram can give you a fast heartbeat.
Cannabis can also make drowsiness worse with escitalopram, especially in people who have just started taking it.
Methadone can increase the risk of side effects in people taking escitalopram.
It can be potentially dangerous to take escitalopram with:
- stimulants like ecstasy (MDMA) or cocaine
- hallucinogens like LSD
- novel psychoactive substances
Escitalopram hasn't been properly tested with recreational drugs.
Talk to your doctor if you think you might use recreational drugs while taking escitalopram.