01Understand your treatment
The big picture.
Escitalopram is a prescription antidepressant taken once a day. In Australia it is used for depression and for some anxiety disorders, including ongoing, hard-to-control worry (generalised anxiety) and social anxiety. It usually takes several weeks to help. This guide is for adults and is a starting point for a conversation with your GP.
Sources1202How it works
A gradual change. Not an instant fix.
Escitalopram blocks the serotonin transporter, which normally clears the chemical messenger serotonin away from nerve cells. This happens quickly, but changes in mood and anxiety build up over several weeks.
Sources12- 01
Low mood
Persistent low mood may gradually ease. It is a daily treatment, not a quick lift or a cure.
- 02
Worry and anxiety
Ongoing worry, fear of social situations and avoidance may gradually become easier to manage.
- 03
Feeling more like yourself
Over weeks, daily life and functioning may improve. Talking therapy and support can work alongside it.
03Your guide
What can I expect?
Escitalopram is a daily medicine that may gradually ease low mood, ongoing worry and avoidance. It does not work straight away. It usually takes several weeks to notice a meaningful change, so keep taking it as prescribed and keep your review appointments.
In studies lasting 8 to 12 weeks, adults with depression or anxiety taking escitalopram improved more on symptom questionnaires than people taking a dummy tablet (placebo). These are group results. They cannot tell you how much you personally will improve.
Medicine is only one part of care. Talking therapies, support and your own goals matter too.
04Your guide
If you are taking it for depression
Escitalopram is approved in Australia for major depression. Your GP will consider how severe your symptoms are, what has helped before, your preferences and whether talking therapy is available. For milder depression, other options may be offered first, depending on what you prefer.
If it helps, treatment usually continues for at least six months after you feel well again. It may continue for longer if depression has come back before. Your GP will plan this with you.
05Your guide
If you are taking it for anxiety
In Australia, escitalopram is approved for generalised anxiety disorder (ongoing worry that is hard to control) and social anxiety disorder (strong fear of social situations).
It is sometimes used for panic disorder. This is called off-label use: panic disorder is not listed in the Australian product information, although there is research supporting it. Your GP will explain why they are suggesting it and what other options exist.
Anxiety that comes with depression is not the same as a separate anxiety disorder. How long you take it depends on your diagnosis and how you respond. Your GP will review this with you.
06Your guide
Taking it each day
Dose steps, once a day
Over 65, the usual maximum ongoing dose is 10 mg. With liver problems, or slow breakdown of escitalopram, 5 mg a day is usual for the first two weeks. Follow your own prescription.
- 10 mgUsual starting dose
- 20 mgIf prescribed; usual maximum
The usual starting dose for adults is 10 mg once a day, with or without food. Depending on how well it works and how you tolerate it, your GP may increase it to 20 mg once a day, the usual maximum.
If you are over 65, the usual maximum ongoing dose is 10 mg a day. People with liver problems, or who are known to break down escitalopram slowly, usually take 5 mg a day for the first two weeks. Follow your own prescription and do not change the dose yourself.
The liquid form contains alcohol and has its own measuring instructions. Ask your pharmacist to show you.
07Your guide
If you miss a dose
If you remember within 12 hours of your usual time, take it then. If it is nearly time for your next dose, skip the missed dose and carry on as normal. Never take two doses to make up for a missed one.
08Your guide
Side effects: what to expect
Side effects in numbers
What does “common” look like?
In short-term studies of adults with depression, people taking escitalopram reported the following effects. Doses of 10 mg and 20 mg a day are combined. Figures from separate generalised anxiety studies are shown in the study details.
Sources4These are people who reported an effect during treatment, not a risk with each tablet. One person could report several effects. A report does not mean the medicine caused every case. The source gives whole-number percentages. “1 in” figures and the 100-person pictures are approximate. Your experience may differ.
Other effects worth knowing about
These were also reported in the same studies. Percentages are for the depression studies, with 10 mg and 20 mg combined.
- Dry mouthMouth feels dry6.0%
- TirednessFatigue or low energy5.0%
- Lower sex driveReduced interest in sex3.0%
About the studies & rates by dose
These are randomised, placebo-controlled adult trials pooled in the US Lexapro label (section 6.1, Tables 2–3). The main figures are the depression pool: 715 people taking 10–20 mg a day. The second column is a separate generalised anxiety disorder pool (429 people); it is not panic disorder or social anxiety data. The trials were short term and the source does not give one exact study length. These are overseas trial figures, not the Australian product information.
Escitalopram: 715 people.
| Effect | Depression pool, 10–20 mgn = 715 | Anxiety (GAD) pool, 10–20 mgn = 429 |
|---|---|---|
| Nausea | 15.0% | 18.0% |
| Trouble sleeping | 9.0% | 12.0% |
| Diarrhoea | 8.0% | 8.0% |
| Drowsiness | 6.0% | 13.0% |
The two columns are separate trial pools, not different doses: both combine 10 mg and 20 mg a day. Rates were generally higher in the anxiety pool, but the studies differed, so do not compare them as if they were one trial. Do not change your dose based on this table.
Sources4What can help?
Tell your GP about side effects rather than changing your dose yourself. Your GP may suggest changing the time of day you take it, taking it with food, or adjusting the dose.
Nausea, trouble sleeping, drowsiness or feeling restless can happen in the first weeks. Tell your GP if they are distressing or do not settle.
Sexual problems, such as lower sex drive or difficulty reaching orgasm or ejaculating, can happen with this type of medicine and are often not mentioned. Please raise them so your GP can review your treatment. In some people, sexual problems continue after stopping; how often this happens is not known.
Do not drive if you feel dizzy, drowsy or have blurred vision. Talk to your GP about alcohol.
09Know when to get help
When to get help
Emergency · Call 000
Call 000 if you are in immediate danger from thoughts of suicide or self-harm, or cannot keep yourself safe. Also call 000 for a seizure (fit), collapse, trouble breathing, or swelling of the face, lips, tongue or throat.
Urgent
Contact your GP or mental health team urgently, the same day, if you have new or worse thoughts of suicide or self-harm, feel very agitated or unable to sit still, or notice unusually high mood, racing thoughts or risky behaviour. This can happen early in treatment or after a dose change.
Urgent
Seek urgent medical care for confusion or agitation together with shaking, muscle twitching or jerks, sweating or fever, especially after starting or increasing another medicine. This could be a reaction called serotonin toxicity.
Urgent
Seek urgent medical care for new confusion, marked weakness or unsteadiness (possible low sodium), fainting or a fast, irregular heartbeat, black stools or unusual bleeding, or a sudden painful red eye or change in vision.
10Plan ahead
Stopping or changing treatment
Do not stop escitalopram suddenly. Stopping can cause withdrawal symptoms such as dizziness, “electric shock” feelings, anxiety, trouble sleeping, or flu-like or stomach symptoms. These can be mistaken for the illness coming back.
When it is time to stop, your GP will plan a gradual reduction, often with smaller steps towards the end. This may take weeks or months. If withdrawal symptoms are severe, tell your GP: going back to the previous dose and reducing more slowly may be needed.
11Plan ahead
Important conversations
Tell your GP and pharmacist about all medicines, including those bought without a prescription and herbal products such as St John's wort. Some combinations need care, including tramadol and some other strong pain medicines, migraine medicines called triptans, lithium, blood thinners, anti-inflammatory pain relievers, aspirin and some heart rhythm medicines. Some reflux medicines (omeprazole or esomeprazole) can raise escitalopram levels.
Do not take escitalopram with medicines called MAOIs (including moclobemide and the antibiotic linezolid) or with pimozide. Switching from another antidepressant needs a specific plan from your GP.
Also mention any history of bipolar disorder or very high mood, seizures, bleeding problems, heart rhythm problems, glaucoma, low sodium, or kidney or liver problems.
12Plan ahead
Pregnancy and breastfeeding
If you are pregnant, planning a pregnancy or breastfeeding, talk to your GP. Untreated depression and anxiety also carry risks, so the decision is about weighing benefits and risks for you and your baby.
Use late in pregnancy has been linked with short-term withdrawal or adjustment symptoms in newborn babies, a newborn breathing and circulation problem (called PPHN), and heavier bleeding after birth. Escitalopram passes into breast milk.
Do not stop suddenly if you find out you are pregnant. Contact your GP to make a plan.
13Your guide
Reviews and follow-up
Expect an early check-in, usually within one to two weeks of starting, and sooner if you are aged 18 to 25 or have had thoughts of suicide. Later reviews look at how you are feeling and functioning, side effects and whether the dose is right, especially after any dose change.
If you are more likely to develop low sodium, for example if you are older or take fluid tablets, your GP may arrange a blood test. Keep going to reviews even when you feel better.