Everything You Need to Know About Escitalopram

Summary

Escitalopram is a prescription medication in a class called selective serotonin reuptake inhibitors (SSRIs). It works by changing how serotonin is handled between nerve cells in the brain and is taken orally. In Canada, escitalopram is available in several strengths and requires a prescription.

What is escitalopram?

Escitalopram is the active ingredient in several prescription medications available in Canada. It belongs to a group of medicines called selective serotonin reuptake inhibitors, or SSRIs.

Rather than simply “increasing serotonin,” escitalopram primarily works by reducing the reuptake of serotonin between nerve cells. This leaves more serotonin available for signalling between these cells. The effects of this change develop over time, which is one reason the medication should be taken consistently rather than adjusted based on how you feel from one day to the next.

Escitalopram is available as an oral medication. Health Canada's Drug Product Database lists both brand-name and generic escitalopram products as prescription medications. Current Canadian records include tablet strengths such as 5 mg, 10 mg, 15 mg and 20 mg, depending on the product.

What is the generic name for escitalopram?

Escitalopram is itself the generic name of the active ingredient. Cipralex is one brand name associated with escitalopram.

Generic and brand-name products contain the same active ingredient, although inactive ingredients and appearance can differ between products. If your pharmacist dispenses a generic product, they can explain how it compares with the medication you were previously taking.

How does escitalopram work in the body?

Escitalopram affects serotonin signalling in the central nervous system. Serotonin is a neurotransmitter, meaning it helps nerve cells communicate with one another.

Escitalopram selectively blocks the serotonin transporter responsible for taking serotonin back up into nerve cells after it has been released. This is called serotonin reuptake inhibition.

It is important not to oversimplify this process as correcting a “serotonin imbalance.” The relationship between serotonin signalling, brain function and mental health is more complex than that explanation suggests. For patient education, it is more accurate to describe escitalopram as changing serotonin signalling over time.

Because these changes are not immediate, some effects of the medication may take time to develop. Your practitioner can explain what to expect based on your prescription and individual circumstances.

How is escitalopram taken?

Escitalopram is taken by mouth, usually once daily. It can generally be taken with or without food, but it is important to follow the directions provided with your prescription.

Try to take it at approximately the same time each day. If it makes you feel sleepy or affects your sleep, your practitioner or pharmacist can help you determine whether changing the time you take it would be appropriate.

Do not change your dose, take it more often or stop taking it because you feel that it is or is not working. Prescription instructions are based on factors such as your age, medical history, other medications and how you respond to treatment.

What is the usual escitalopram dosage?

The appropriate dose varies from person to person. Canadian product information includes tablet strengths of 5 mg, 10 mg, 15 mg and 20 mg, but the strength prescribed to you may be different from someone else's.

Your prescribed dose should be followed exactly. A higher dose is not necessarily more appropriate, and changing your dose without professional guidance can increase the risk of side effects.

Important: Do not use another person's dose as a guide for your own treatment. Escitalopram dosing should be individualized by a practitioner.

What are the side effects of escitalopram?

Like any prescription medication, escitalopram can cause side effects. Some are more common when treatment begins and may improve as your body adjusts, while others require medical attention.

Potential side effects can include:

• nausea
• headache
• dry mouth
• sweating
• changes in sleep
• drowsiness or fatigue
• dizziness
• constipation
• changes in sexual function

Not everyone experiences side effects, and experiencing a side effect does not necessarily mean that you need to stop taking the medication. If a side effect is persistent, bothersome or concerning, speak with your pharmacist or practitioner rather than stopping the medication on your own.

Can escitalopram affect sexual function?

Yes. Changes in sexual function can occur with SSRIs, including changes in sexual interest, arousal or orgasm.

If you notice a change that is affecting your quality of life, speak with your practitioner. They can help determine whether it may be related to your medication and discuss appropriate options.

What medications interact with escitalopram?

Escitalopram can interact with other medications and substances. This is particularly important because some interactions can increase the risk of serious side effects.

Tell your practitioner and pharmacist about everything you take, including prescription medications, over-the-counter products, vitamins and supplements.

Particular attention may be needed with medicines or substances that affect serotonin, medications that increase bleeding risk, and certain drugs that can affect heart rhythm.

Do not assume that a medication is safe to combine with escitalopram simply because it is available without a prescription. Your pharmacist can check for potential interactions before you start a new medication or supplement.

What should you know before stopping escitalopram?

Escitalopram should generally not be stopped suddenly unless a practitioner specifically tells you to do so.

Stopping an SSRI too quickly can cause discontinuation symptoms. These can include dizziness, headache, nausea, changes in sleep, unusual sensations and flu-like feelings.

The approach to stopping treatment depends on factors such as the dose you are taking, how long you have been taking it and your individual circumstances. A practitioner can recommend an appropriate plan rather than having you make the change yourself.

Do not confuse discontinuation symptoms with addiction. Experiencing symptoms after stopping an SSRI does not by itself mean that you have developed an addiction. It is one reason these medications are generally reduced gradually when treatment is being stopped.

What serious risks should you know about?

Most people do not experience serious complications, but escitalopram has important safety considerations that should not be overlooked.

Escitalopram can increase the risk of bleeding, particularly when taken with certain other medications. It can also cause serotonin syndrome when combined with other substances that increase serotonin. Serotonin syndrome can be serious and requires urgent medical attention.

Escitalopram may also affect heart rhythm in some people. Your practitioner may need to consider your medical history, other medications and other risk factors before prescribing it.

As with other antidepressant medications, changes in mood or behaviour, including suicidal thoughts or unusual agitation, should be taken seriously. Seek urgent medical attention if you feel that you may hurt yourself or someone else.

What does the research say about escitalopram?

Escitalopram has been extensively studied in randomized controlled trials and systematic reviews. Earlier research established its clinical efficacy, while more recent reviews continue to examine how it compares with other medications and how well it is tolerated.

A 2023 systematic review and meta-analysis examined 30 randomized controlled trials comparing escitalopram with other antidepressants. The review evaluated measures including response, remission and tolerability rather than relying on a single clinical trial.

For Canadian clinical context, it is also important to use current guidelines rather than relying solely on older recommendations. CANMAT published an updated evidence-based guideline for adults in 2023, replacing the need to rely on the 2016 depression guideline cited in the original article.

Research should therefore be presented as evidence about the medication, not as a guarantee that it will produce a particular result for an individual. Response and tolerability can vary considerably from person to person.

Who should speak with a healthcare practitioner before taking escitalopram?

Before starting escitalopram, tell your practitioner about your medical history and all medications or supplements you take.

It is especially important to discuss any previous reactions to antidepressants, other medications that affect serotonin or bleeding, heart rhythm concerns, seizure history, pregnancy or plans to become pregnant, and any significant changes in mood or behaviour.

Your practitioner can review your individual circumstances, check for potential interactions and determine whether escitalopram is appropriate for you.

When should you speak with a healthcare practitioner?

Speak with a practitioner if you are experiencing persistent or bothersome side effects, are considering changing your dose, have missed doses repeatedly or are thinking about stopping escitalopram.

You should also seek prompt medical attention for symptoms such as severe agitation, confusion, fainting, unusual bleeding, seizures, severe allergic reactions or thoughts of harming yourself or someone else.

A pharmacist can also be a useful first point of contact for questions about how to take escitalopram, missed doses, interactions and medication-related side effects.

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Frequently Asked Questions

What is escitalopram?

Escitalopram is a prescription medication in the selective serotonin reuptake inhibitor (SSRI) class. It works primarily by reducing the reuptake of serotonin between nerve cells, changing how serotonin signalling occurs in the brain.

What are the side effects of escitalopram?

Potential side effects include nausea, headache, dry mouth, sweating, dizziness, drowsiness, changes in sleep and sexual side effects. Side effects vary between people. Speak with a pharmacist or practitioner if a side effect is persistent, severe or concerning.

What is the usual escitalopram dosage?

There is no single dose that is appropriate for everyone. Canadian products are available in several strengths, including 5 mg, 10 mg, 15 mg and 20 mg. Your prescribed dose depends on individual factors and should not be changed without guidance from your practitioner.

Can you stop taking escitalopram suddenly?

Stopping escitalopram suddenly can cause discontinuation symptoms. If treatment needs to be stopped, your practitioner can recommend an appropriate approach based on your dose, treatment history and individual circumstances.

Is escitalopram addictive?

Escitalopram is not generally considered an addictive medication. However, stopping it abruptly can cause discontinuation symptoms. This is different from addiction and is one reason treatment should not be stopped suddenly without speaking with a practitioner.