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LEXAPRO FAQS: Side-Effects of LEXAPRO
Below are the answers to frequently asked questions about the SSRI antidepressant
LEXAPRO (escitalopram oxalate). The answers are provided by HealthyPlace.com Medical
Director, Harry Croft, MD, a board-certified psychiatrist.
As you are reading these answers, please
remember these are "general answers" and not meant to apply to your
specific situation or condition. Keep in mind that editorial content is never a
substitute for a visit to a health care professional.
In clinical trials, LEXAPRO was shown to be well
tolerated by most adult patients with many of the side effects disappearing in the
first few weeks.
The most common adverse events reported with LEXAPRO
vs placebo (approximately 5% or greater and approximately 2X placebo) were nausea,
insomnia, ejaculation disorder, somnolence, increased sweating, fatigue, decreased
libido, and anorgasmia. LEXAPRO is contraindicated in patients taking monoamine
oxidase inhibitors (MAOIs) or in patients with a hypersensitivity to escitalopram
oxalate or any of the ingredients in LEXAPRO. Lexapro is contraindicated in patients
taking pimozide (see DRUG INTERACTIONS - Pimozide and Celexa). As with other SSRIs,
caution is indicated in the coadministration of tricyclic antidepressants (TCAs)
with LEXAPRO. As with other psychotropic drugs that interfere with serotonin
reuptake, patients should be cautioned regarding the risk of bleeding associated
with the concomitant use of LEXAPRO with NSAIDs, aspirin, or other drugs that
affect coagulation.
Patients with major depressive disorder, both adult
and pediatric, may experience worsening of their depression and/or the emergence
of suicidal ideation and behavior (suicidality), whether or not they are taking
antidepressant medications, and this risk may persist until significant remission
occurs. Although no causal role for antidepressants in inducing such behaviors has
been established, patients being treated with antidepressants should be observed
closely for clinical worsening and suicidality, especially at the beginning of a
course of drug therapy, or at the time of dose changes, either increases or decreases.
Q: Will LEXAPRO cause sleeping problems, insomnia, too
much sleep, or frequent drowsiness?
A: In clinical trials for depression, 9% of
patients taking Lexapro experienced insomnia and 6% experienced drowsiness, compared
with 4% and 2%, respectively, of those taking placebo. In clinical trials for generalized
anxiety disorder, 12% of Lexapro-treated patients experienced insomnia and 13% experienced
drowsiness, compared with 6% and 7%, respectively, of patients taking placebo. Many of
the side effects of Lexapro are transient or mild, and tend to go away with continued
treatment.
Q: Will LEXAPRO cause an upset stomach or nausea?
A: Most antidepressant medications can cause
gastrointestinal (GI) side effects in some people. This is because there are more
serotonin receptors in the GI tract than anywhere else in the body. However, in
clinical trials for depression, Lexapro showed a low incidence of gastrointestinal
side effects vs placebo. In fact, the only GI adverse event to occur in more than 10%
of depressed patients was nausea, and nausea symptoms were generally mild and resolved
over time.
Q. Will LEXAPRO affect my sex drive?
A: Although changes in sexual desire, sexual performance,
and sexual satisfaction may occur during a depressive episode, they may also be a consequence
of treatment with SSRI therapies. Reliable estimates of changes in sexual behavior related
to medication are difficult to obtain, because patients and physicians are often reluctant
to discuss them. In clinical trials, a low percentage of patients taking LEXAPRO have
reported sexual side effects, primarily ejaculatory delay in men. Additionally, decreased
libido has also been reported at a low rate in clinical trials. If you have questions
about sexual dysfunction, speak with your healthcare professional.
Q: What about taking a break from the medication
for a few days to relieve side effects such as sexual dysfunction?
A: I do not recommend taking a break for two reasons:
First, it sends the message that it is okay not to take your antidepressant now and
then, when in fact it is very important to stay with the medication to have its
full effect; second, patients may experience serotonin discontinuation
symptoms—flu-like symptoms, nightmares, muscle aches, and increasing anxiety or
insomnia after 1 or 2 missed doses. For these reasons, I think a break from the
medication is, in general, not a good idea.
Q. Will LEXAPRO cause weight gain?
A: In studies, adult patients treated with LEXAPRO
experienced no clinically important weight change as a result of therapy. If you have
concerns about any side effects, you should talk with your healthcare professional or doctor.
Q. Will LEXAPRO cause anxiety symptoms such as
racing/pounding heart, lightheadedness, agitation, restlessness, panic attacks?
A: An increase in anxiety and related symptoms may
occur when taking SSRIs early within the first few days or weeks. LEXAPRO has been
shown to improve anxiety symptoms associated with depression by week 2 of treatment.
Occasionally, in very anxious patients, starting with a smaller dose for the first
few weeks helps, but it is generally best to "wait it out." If the anxiety symptoms
associated with depression cause too much suffering, the physician can prescribe
medications to lessen the anxiety, and then stop these medications within a few weeks
when the anxiety is gone.
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