An SSRI antidepressant
Escitalopram
A widely used SSRI for depression and anxiety, closely related to citalopram and generally well tolerated.
What is Escitalopram?
Escitalopram is a selective serotonin reuptake inhibitor (SSRI) and one of the most commonly prescribed antidepressants in the UK. It is used for depression and for several anxiety conditions, including generalised anxiety and panic disorder.
Education and reference only. This is a plain-language guide to Escitalopram — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Escitalopram is a selective serotonin reuptake inhibitor (SSRI), one of the most commonly prescribed antidepressants in the UK. It is used for depression and for several anxiety conditions, and is often a first-choice SSRI because it is effective and generally well tolerated. It is the closely related "mirror-image" partner of citalopram. It is a long-term, once-daily tablet that builds its effect over weeks. It is sold as Cipralex in the UK and Lexapro in the US.
How it works
Escitalopram increases the activity of serotonin, a natural chemical messenger in the brain, by slowing its reabsorption back into nerve cells so that more remains available to pass signals. Over a few weeks this is thought to help restore the balance of brain chemistry involved in mood and anxiety, gradually lifting low mood and calming anxiety. It is "selective", meaning it mostly affects serotonin rather than other messengers, which tends to make its side-effect profile more predictable.
Company & origin
Originated / developed by: H. Lundbeck.
Escitalopram is the active (S)-enantiomer of citalopram, developed by Denmark's H. Lundbeck (with Forest Laboratories in the US). It was first approved in Europe in late 2001 and by the US FDA in 2002, marketed as Cipralex/Lexapro.
What it treats
Conditions Escitalopram is used for
Practical use
How to take Escitalopram
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- Usually taken once a day, with or without food, at a time that suits you.
- It often takes a few weeks before you feel the full benefit, so keep taking it steadily.
- Do not stop abruptly, as this can cause discontinuation symptoms; your doctor will reduce it gradually.
- Tell your doctor if your mood worsens or you have distressing thoughts, particularly in the first few weeks.
- Avoid drinking much alcohol, which can worsen low mood and drowsiness.
- Check before taking new medicines, as some interact with SSRIs.
Weighing it up
Advantages & disadvantages of Escitalopram
Advantages
- Generally well tolerated and a common first-choice antidepressant.
- Effective for both depression and anxiety conditions.
- Taken once daily and available as an inexpensive generic.
Disadvantages
- Side effects such as nausea, sleep changes and reduced sex drive can occur.
- Stopping suddenly can cause discontinuation symptoms, so it needs tapering.
- Takes several weeks to work fully.
- Can interact with other medicines, so always check first.
Practical use
Good to know
It usually takes a couple of weeks to begin helping and several weeks for the full effect, so it is worth persevering. Like all SSRIs it is reduced gradually rather than stopped suddenly, to avoid discontinuation symptoms. Escitalopram can slightly affect the heart's electrical rhythm (the "QT interval"), so there is a maximum amount it is given at — particularly in older people and those with heart conditions — and certain combinations are avoided. In adults under twenty-five, mood and any thoughts of self-harm are watched more closely early on.
Who should not take it / use with caution
- People with certain heart-rhythm conditions, or a tendency to a prolonged "QT interval", and care alongside other medicines that affect heart rhythm.
- People taking certain older antidepressants (MAOIs) — these must not be combined with it.
- Used with care in pregnancy and breastfeeding, in liver problems, and where there is a raised bleeding risk.
Monitoring
- Mood and, in younger adults, any thoughts of self-harm early on
- Heart rhythm and blood salts (sodium) where relevant
- Tolerability and response
Side effects
- Feeling sick, headache, dry mouth, sweating, or sleep changes, especially in the first weeks.
- Anxiety or restlessness that may briefly increase before settling, and sexual difficulties.
- Rarely, a change in heart rhythm, low blood sodium (more in older people), or serotonin syndrome (agitation, shivering, sweating, a racing heart) — seek urgent advice if these occur.
Key interactions
- It must not be combined with certain older antidepressants (MAOIs), and care is needed with other serotonin-boosting medicines, including some painkillers, triptans and St John's wort.
- It is avoided or used cautiously with other medicines that prolong the heart's QT interval, such as some antibiotics, antipsychotics and heart-rhythm drugs.
- Combining it with aspirin, antiplatelets, anticoagulants or some NSAID painkillers raises bleeding risk.
Available as: Tablets and oral drops (a liquid form).
Answers
Escitalopram: frequently asked questions
How long does escitalopram take to work?
It usually takes about two weeks to start helping and several weeks for the full benefit, so it is worth continuing even if you feel no change at first — and sometimes side effects ease as the benefit grows. If there is no improvement after a fair trial, your prescriber can review it.
Why is there a limit on how much escitalopram can be given?
Escitalopram can slightly affect the heart's electrical rhythm (the "QT interval") in a way that grows at higher amounts, so there is a ceiling on how much is used — especially in older people and those with heart conditions. Staying within that limit and avoiding certain combinations keeps it safe.
How is escitalopram different from citalopram?
They are closely related — escitalopram is essentially the "active half" of citalopram, so it works at lower amounts and is sometimes felt to be a little cleaner in its effect. Both are SSRIs used for depression and anxiety, and your prescriber chooses between them based on your history and tolerance.
Why can't I stop escitalopram suddenly?
Stopping an SSRI abruptly can cause discontinuation symptoms such as dizziness, flu-like feelings, "electric-shock" sensations and irritability. To avoid this it is reduced gradually under guidance when you decide to stop. Never stop it on your own without a tapering plan.
Cipralex or Lexapro — are these different medicines?
No. They are the same medicine — escitalopram is the generic (active-ingredient) name, Cipralex is the UK brand name and Lexapro is the US brand name. If you see either name on a prescription or packaging abroad, the active ingredient is identical.
The wider class
About SSRIs
Escitalopram belongs to the ssris class. For how the class as a whole works, its shared safety principles and monitoring, see the full guide.
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Authoritative sources
- BNF: Escitalopram.
- electronic Medicines Compendium (SmPC): Cipralex.
- NICE CKS: Escitalopram.
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