Lexapro Side Effects First Week: what to expect, and more

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Drug side effects may sound alarming; however, they should be expected when taking new medication. This is particularly true during the first couple of days or the first week. In some cases, side effects may persist even if the individual has been taking the medication for some time. Such is often the case with prescription drugs, particularly antidepressants like Lexapro. This article discusses Lexapro side effects first week of usage.

The impact of medication side effects can range from mild inconveniences to severe hindrances that can impact one’s daily life. Understanding that not all side effects necessitate immediately halting medication intake is vital. It all depends on the severity of the adverse effects and the person taking the drug. In many situations, the benefits of a particular medication can greatly outweigh its minor and temporary side effects. Read on to know more about Lexapro side effects first week of usage.

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What Is Lexapro?

Lexapro is an antidepressant medication and comes as an oral prescription drug. Lexapro helps ease the symptoms of moderate and severe depression. It does so by affecting serotonin activity and serotonin levels in the brain. Lexapro is the brand name for escitalopram, which is available in tablet and liquid solution dosage forms. It can be prescribed and used alone or with other medications.

Lexapro Drug Indications

Lexapro has two official drug label indications. The U.S. Food and Drug Administration (FDA) approved its use as a treatment for generalized anxiety disorders and depression. The drug is indicated to be safe and effective for adults. Lexapro is also deemed safe and effective for pediatric patients with MDD, but only for patients over the age of 12 years. The prescription medication is not allowed or considered safe as a GAD treatment for children below 18 years old.

Lexapro also has several off-label indications. Therefore, doctors may prescribe Lexapro to treat the conditions aside from MDD and GAD, despite the absence of official approval from the FDA. These off-label indications include:

  • Obsessive-compulsive disorder (OCD)
  • Panic disorder
  • Post-traumatic stress disorder (PTSD)
  • Insomnia
  • Premenstrual dysphoric disorder
  • Vasomotor symptoms associated with menopause
  • Some eating disorders

Although the FDA has not officially approved these off-label indications, there is already existing clinical significance to support the drug’s use. However, since these are still off-label indications, Lexapro and its manufacturer cannot officially market the drug as a treatment for these mental and physical health conditions, regardless of its effectiveness.

How Lexapro Works

Lexapro falls under a class of drugs called selective serotonin reuptake inhibitors (SSRI). This group of drugs is the most commonly prescribed type of antidepressant. As an SSRI, Lexapro works in two parts. First, it increases the amount of serotonin in the brain and body.

Serotonin, or 5-hydroxytryptamine (5-HT), is known as the happy or feel-good hormone. Serotonin influences happiness and memory. Higher serotonin levels, therefore, play a prominent role in keeping depression and anxiety at bay.

Second, Lexapro blocks the reuptake or reabsorption of serotonin into the neurons or nerve cells in the brain. As a neurotransmitter, serotonin acts as a chemical messenger. It carries signals from one neuron to another. Blocking the reabsorption of serotonin into the neurons causes more serotonin to stay in the brain and the body for extended periods. This means the brain has more messengers to send signals between the neurons.

The increased serotonin and better neurotransmission in an individual’s system also help promote better emotional regulation, mood, metabolism, and sleep. As such, Lexapro may also help patients dealing with other mental health conditions with similar symptoms. Physicians may prescribe Lexapro for other mental health concerns via off-label indications like insomnia, PTSD, and eating disorders.

Common Lexapro Side Effects First Week of Dosage

Patients may experience some side effects after taking Lexapro that are similar to most adverse effects associated with other antidepressants and SSRIs. However, note that the adverse effects experienced by two people taking Lexapro may differ, as the drug may interact differently with their brain and body. Many Lexapro side effects from the first week or two of treatment go away on their own as the treatment continues.

22 Common Lexapro Side Effects First Week of Dosage

The most common Lexapro side effects first week of dosage may include:

  • Nausea
  • Fatigue or lethargy
  • Dizzy spells or feeling shaky
  • Headaches
  • Confusion
  • Somnolence or drowsiness
  • Trouble sleeping or insomnia
  • Anxiety
  • Dry mouth
  • Constipation
  • Indigestion
  • Vomiting
  • Diarrhea
  • Decreased appetite
  • Increased sweating
  • Decreased libido or sexual desire
  • Anorgasmia or difficulty reaching orgasm
  • Neck or shoulder pain
  • Abdominal pain
  • Flu-like symptoms
  • Rhinitis
  • Weight gain

Lexapro side effects in the first week are generally the same for both men and women. However, the side effects that adults and children experience are often different. Lexapro side effects during the first week of intake for children and teenagers over 12 years old may also include the following:

  • Nosebleeds
  • Increased thirst
  • Urinary retention or difficulty urinating
  • Heavy menstrual periods
  • Slower growth
  • Weight change or weight loss
  • Decreased appetite
  • Agitation or abnormal increase in muscle movement

Lexapro side effects during the first week of treatment are generally mild; they typically subside without further medical help. However, you should report to a medical professional if the adverse effects persist beyond the first couple of weeks.

Serious Side Effects of Lexapro

In most cases, Lexapro’s side effects in the first week are mild. However, there are cases in which more serious adverse effects are observed.

Lexapro treatments can potentially cause panic attacks. In addition, patients with a history of bipolar disorder or mania have a higher risk of entering hypomania or a manic episode due to taking Lexapro. The drug may also cause hyponatremia or low blood sodium levels and angle-closure glaucoma, leading to blindness in only a few hours.

Patients who exhibit this adverse effect are often elderly or geriatric. Due to their age, such conditions can have much more severe health consequences. In addition, they are also at risk of experiencing liver problems due to Lexapro.

Below are other severe side effects to watch for when taking Lexapro:

Suicidal Thoughts or Actions: Taking Lexapro may increase a patient’s suicidal thoughts, leading to a higher risk of suicidal actions. This particular side effect is more likely among children, adolescents, and young adults. This is partly why Lexapro dosage and indications for children and teens are still limited.

The increase in suicidal thoughts and actions typically happens within the first couple of months of Lexapro treatment rather than within the first week. The risk also goes up when patients increase their prescribed dosage. Some symptoms of greater suicidal risk are:

  • Greater impulsivity, particularly towards dangerous activities
  • Aggressive actions or violent tendencies
  • New or worse depression
  • New or worse anxiety and panic attacks
  • Unusual or risky behaviors
  • Panic attacks
  • Mood swings

Severe Allergic Reactions: Some patients may experience severe allergic reactions after taking Lexapro. This may be due to the drug or other medicine ingredients. For example, individuals allergic to Celexa (citalopram), another antidepressant, will also experience a severe reaction to Lexapro.

  • Symptoms of severe allergic reactions to Lexapro include:
  • Difficulty breathing
  • Trouble swallowing or talking
  • Swollen face, lips, tongue, throat, or eyes
  • Severe skin rash or hives
  • Itchiness
  • Peeling skin
  • Blisters
  • Fever
  • Joint pain

Seizures or Convulsions: Cases of convulsion have been observed during Lexapro clinical trials. Similarly, once the drug was made publicly available, rare grand mal seizures were included in postmarketing reports. Patients with a history of seizures and nervous system disorders are cautioned against taking Lexapro. The treatments can potentially worsen their existing condition and put them at a higher risk of experiencing convulsions and seizures as a side effect.

Severe seizures may also result from taking escitalopram with monoamine oxidase inhibitors (MAOIs), such as Marplan, Zyvox, or Nardil.

Serotonin Syndrome: Serotonin toxicity is perhaps the most severe among all potential Lexapro side effects in the first week of treatment. It is a severe condition caused by excessive serotonin. Although serotonin is necessary for the body to function optimally, dangerously high hormone levels can be fatal. Serotonin toxicity is characterized by the following signs and symptoms:

  • Shivering
  • Goosebumps
  • Diarrhea
  • Confusion
  • Agitation or restlessness
  • Hallucinations
  • Insomnia
  • Muscle rigidity or severe muscle tightness
  • Loss of muscle coordination
  • Rapid heart rate
  • High blood pressure
  • Heavy sweating
  • Fever

Seizures and tremors: Severe cases of serotonin toxicity are marked by equally more serious symptoms. Fevers are higher, the heartbeat becomes irregular, and seizures and tremors worsen. In some cases, the patient may faint or become unconscious.

Upon recognizing these signs, patients are advised to call for help and seek immediate medical attention.

Lexapro Side Effects in Women

Although Lexapro’s side effects in the first week are generally the same for both men and women, there are a few exceptions.

Gestating women, particularly those already in the last trimester of pregnancy, may experience unique side effects due to Lexapro. Most of these adverse effects concern the baby rather than the mother. The prescription does not cause premature birth or any birth defects. However, it can increase the baby’s risk of being born with poor adaptation or pulmonary hypertension.

Mothers who just gave birth and women who are nursing babies are advised against taking Lexapro as escitalopram can be transferred into breast milk. When ingested by the infant, it can cause restlessness, agitation, sedation, or issues with gaining weight.

Lastly, Lexapro may cause heavy menstruation. This side effect may affect adults, adolescents, and preadolescents alike.

Lexapro Side Effects in Men

Sexual dysfunction is one of the common Lexapro side effects in the first week. This typically manifests by way of decreased libido or sexual performance. Unfortunately, such symptoms and adverse effects often persist as long as the patient takes Lexapro.

Among men, these adverse sexual effects may also include erectile dysfunction. It is relatively common for men taking Lexapro to experience the inability to have an erection or difficulty keeping one. They may also experience ejaculatory delay or impaired ejaculation.

Patients are advised to consult a healthcare professional regarding such side effects. The doctor may adjust the dosage or change the prescription in cases with significant adverse effects.

Lexapro Warnings and Drug Interaction

Almost all prescription medications come with warnings, directions, and information about how they interact with other drugs. These are essential for the patient’s health and the safe intake of the drug.

Lexapro Warnings

Prescription warning labels provide all the pertinent cautionary information to ensure the safe administration or intake of the drug. Lexapro comes with a black box warning from the FDA. This is the strictest warning that the agency gives for prescription medications.

A black box warning, occasionally simply referred to as a “boxed warning,” informs doctors and patients of the serious safety risks that the prescription poses. These warnings are printed in bold font and placed inside a black border, hence the name. The boxed warning regarding Lexapro primarily concerns the drug’s association with an increased risk of suicidal thoughts and behaviors.

Below are some of the important points included in the Lexapro boxed warning:

  • There is an increased risk of suicidal thoughts and actions in children, adolescents, and young adults taking the medication for MDD.
  • Patients over 24 years showed no signs of higher suicide risk when taking Lexapro.
  • Those with depression and other psychiatric disorders have a higher suicide risk when taking Lexapro.
  • Patients should be closely observed while they adjust to Lexapro.
  • Lexapro is not approved for children below 12 years of age.

Lexapro Drug Interactions

Aside from the boxed warning, Lexapro also carries warnings regarding how it interacts with other drugs.

How drugs interact with other medications can pose a significant potential threat to the health and well-being of the patient. Therefore, knowledge of how the medication interacts with other drugs or chemicals is essential to reduce the risk of harmful side effects and fatalities.

Lexapro has many known interactions with several types of drugs. Sometimes, interactions with other drugs require doctors to prohibit patients from taking Lexapro or changing their other medication. In other cases, the medicines may still be prescribed or taken together, but with a change in dosage.

The following drugs must never be taken with Lexapro:

MAO Inhibitors (MAOIs): These include Marplan (isocarboxazid) and Nardil (phenelzine). MAOIs are antidepressants that affect neurotransmitters, resulting in higher brain serotonin, dopamine, and norepinephrine levels. Patients are advised against using Lexapro within two weeks of taking MAOI.

Blood thinners: These include aspirin, warfarin, and non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen. Taking blood thinners and Lexapro simultaneously can lead to a higher risk of bleeding. A study has also linked the combined use of NSAIDs and SSRIs like Lexapro to a 40% higher likelihood of developing severe gastrointestinal bleeding.

Pimozide: This is an antipsychotic drug used to help control Tourette’s disorder. In addition, it is sometimes used to treat behavior problems in adults with dementia. However, it is not FDA approved for such indication.

Celexa (citalopram): Celexa is another antidepressant SSRI used to treat major depressive disorders or MDD.

Intravenous methylene blue: This injection treats methemoglobinemia, a condition wherein the blood cannot deliver oxygen throughout the body. Taking Lexapro with methylene blue IV may raise the patient’s risk of developing serotonin syndrome.

St. John’s wort: An herbal supplement typically used for depression and menopausal symptoms. When taken with antidepressant drugs, it causes a higher likelihood of serotonin buildup or serotonin syndrome.

In general, medications that positively affect serotonin levels should either be taken in moderation with Lexapro or not. Potential interactions should be discussed at length with the patient’s doctor.

Coping With Lexapro Side Effects

Lexapro side effects in the first week of treatment will typically subside on their own as the patient’s body adapts to the new medication. However, there are instances where even common side effects may be intolerable for the patient.

Below are tips to help patients combat some Lexapro side effects in the first week:

For nausea: Take the medication with food and drink plenty of water and other fluids throughout the day.

For increased appetite and weight gain: Temporarily cut back on sweets and sugary drinks. Eat more low-calorie yet nutritious food like fruits and vegetables while avoiding unhealthy foods or saturated fats.

For fatigue and drowsiness: Engage in regular physical activity or exercise. If the physician approves, take Lexapro before bedtime instead of in the morning.

For insomnia: If the doctor agrees, take the medicine in the morning. Avoid coffee and other caffeinated beverages or food in the afternoon and evening.

For dry mouth: Be mindful about breathing through the nose. Sip water regularly and avoid caffeinated drinks and alcohol.

For constipation: Eat plenty of fiber-rich foods like fruits and whole grains. In addition, drink more water and take a doctor-approved fiber supplement.

For anxiety: Increase physical activity or exercise. Yoga is recommended as it helps patients practice meditation and relaxation techniques.

Taking Lexapro Safely

It is essential to remember any cautionary reminders or warnings that doctors may give. Patients should tell their physician about any other medications they may already be taking; this applies to any supplements or herbal remedies. This will help prevent severe adverse effects and ensure safe and effective treatment.

Moreover, being completely honest regarding one’s medical history is essential. Patients must also inform their physician about medications they may have just finished taking. Some medicines may still affect the patient and the effectiveness of Lexapro even after a week or two has passed.

Women should also inform their doctor should they suspect they are pregnant, especially if they have confirmed it. Lexapro may cause pregnancy complications, though the benefits may outweigh the potential risks. In cases like this, the doctor should be informed of the situation to help the patient make a well-informed decision backed by science.

Proper storage of medicine is also necessary to take Lexapro safely. The tablets or oral solution should always be stored in a closed container at room temperature. It must be kept away from direct light, heat, and moisture.

Lexapro tablets come in three dosage strengths: 5 mg, 10 mg, and 20 mg. The recommended Lexapro dosage depends on each patient’s case and the indication or condition it is supposed to treat. Therefore, the prescribed Lexapro dosage may differ for adults and children. Remember that patients should follow their doctor’s dosage instructions rather than the averages.

The average recommended dosage for children or adolescents over age 12 who have depression is 10 mg per day. Physicians may recommend increasing the dose to 20 mg daily based on its effectiveness. However, this should only be applied after a minimum of three weeks from the start of the treatment.

Below are the typical prescription dosages for on- and off-label Lexapro indications for adults:

Major depressive disorder: 10 mg once daily in the mornings or evenings to start; may increase the dose to 20 mg daily after a week of treatment

Generalized anxiety disorder: 10 mg once daily in the morning or evening; may increase dose up to 20 mg per day following a week of treatment and assessment.

Obsessive-compulsive disorder: for this off-label indication, doctors generally prescribe 10 mg each day, with an option to raise the dosage to 20 mg each day after one week of treatment

Vasomotor symptoms linked to menopause: 10 mg daily; may increase the dose to 20 mg daily, but only after a minimum of four weeks of treatment.

Insomnia due to depression: between 5 mg to 20 mg daily over a two-month or eight-week period

Insomnia due to panic disorder (women only): between 5 mg to 10 mg daily over a two-month or eight-week period

What to Do When I Miss a Dose?

It is always recommended to stick to indicated dosage and timing when taking prescription medications. In case of missing a Lexapro dose, patients are generally advised to take the missed dose as soon as possible. However, if the time falls within a few hours of the next regular dose, it is best to skip the missed dose. Instead, patients should simply wait until the next scheduled dose. Doctors prohibit taking two doses at once, taking two in close intervals, or taking higher doses to reduce the risk of overdose.

What to Do if You Overdose

If a Lexapro overdose happens, it is best to seek emergency medical attention. Patients, relatives, friends, or guardians are advised to call their physician or 911 immediately. Contacting the poison control center is also recommended. Lexapro prescriptions are generally given with the smallest quantity of tablets. Combined with good patient management, this aims to lessen the risk of overdose. Postmarketing reports have indicated Lexapro overdoses of over 1,000 mg and escitalopram overdoses of up to 600 mg. Fortunately, there are little to no fatal Lexapro and escitalopram overdose cases.

Symptoms that accompany a Lexapro overdose may include the following:

  • Convulsions
  • Dizziness
  • Nausea
  • Vomiting
  • Insomnia
  • Somnolence or sleepiness
  • Hypotension or low blood pressure
  • Sinus tachycardia or sudden racing heart
  • Changes in ECG
  • Rare cases of acute renal failure

10 symptoms of Lexapro overdose

Currently, there is no specific treatment or antidotes for reversing the effects of overdosing on Lexapro or escitalopram. Before the arrival of emergency medical technicians, it is best to establish an airway to ensure that the overdosing patient gets sufficient ventilation and oxygenation.

Frequently Asked Questions

Yes, Lexapro may cause greater anxiety during the first weeks of treatment. However, this side effect is typically mild and can be managed with more exercise and relaxation techniques.

Confusion, dizziness, weakness, and sleepiness are four of the first week’s most common Lexapro side effects. However, these adverse effects are generally considered normal and not a cause for concern.

If these symptoms or feelings persist beyond the first week or two, consult the prescribing doctor.

Yes, it can. Like other depressants, specifically SSRIs, Lexapro can cause anxiety to worsen before patients start to feel the effects of increased serotonin in their brain.

Yes, it can. Lexapro can cause fatigue, lethargy, sleepiness, and weakness. In some cases, the feelings of extreme tiredness may stem from other side effects, such as insomnia or trouble sleeping.

Lexapro starts to work as soon as the body metabolizes the drug. The onset of the effect can start in a matter of hours as the medication influences the brain’s function and serotonin levels. However, patients may start to see or feel the results later. In most cases, patients report feeling the effects of Lexapro after four weeks or a month of treatment. However, some patients report noticing the effects after six weeks have passed.

The difference in when people notice the effects of Lexapro may be due to the placebo effect or to how each individual’s body reacts to the medication.

Insomnia due to Lexapro intake does not usually last long. Patients can expect the side effect to subside after the first two weeks of treatment. However, if Lexapro-induced insomnia lasts for several weeks, it is best to consult the prescribing doctor.

Do I need to stop? Anxiety is a common Lexapro side effect in the first week. However, there is no need to stop taking Lexapro unless a doctor orders it. Never stop using Lexapro without first consulting the prescribing physician.

The content on Doctor Alexa’s blog is reviewed by Advanced practice registered nurses or pharmacist and is intended for educational purposes only. This information should not be relied upon as professional medical counsel. Be sure to always consult with your physician about the dangers and benefits of any medication, treatment or procedure.

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