Escitalopram
Brand names: Lexapro
Class: 🧠 SSRIs & SNRIs
On board day, escitalopram is the SSRI you reach for when tolerability matters most. It is an enantiopure form of citalopram with FDA approval for major depression and generalized anxiety disorder. The full antidepressant effect takes 4–6 weeks; GI upset, headache, and mild insomnia appear in the first days. Escitalopram has fewer drug interactions than paroxetine or fluoxetine (less CYP inhibition) and a milder sexual side-effect profile than sertraline at equivalent efficacy. It still carries a QT-prolongation signal at higher doses — keep below 20 mg in older adults. Watch for serotonin syndrome with tramadol, MAOIs, linezolid, or triptans. Taper, do not stop abruptly, to avoid discontinuation syndrome.
✅ Indications
MDD, GAD.
⚙️ Mechanism of Action
SSRI (S-enantiomer of citalopram).
📏 Dosing
10–20 mg PO daily.
🚫 Contraindications
MAOI within 14 days.
⚠️ Adverse Effects
Sexual dysfunction, nausea, insomnia/somnolence, discontinuation syndrome, QT (less than citalopram), serotonin syndrome.
🔬 Monitoring
Mood, suicide screen early; no routine ECG.
💎 Board Pearls
- 💊 Cleaner side-effect profile than citalopram (no QT black box at standard doses).
- 💡 Go-to SSRI for GAD as first-line monotherapy.
- 📉 Max 10 mg in elderly.
Practice Questions
A 74-year-old patient is being started on escitalopram for generalized anxiety disorder. Which of the following is the correct maximum daily dose in this patient population based on FDA labeling?
Related Drugs in This Class
- Sertraline — Zoloft
- Fluoxetine — Prozac
- Venlafaxine — Effexor XR
Sources
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