How it works
What does escitalopram do?
Escitalopram is a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI).
Research suggests that depression or low mood is more likely to occur when the brain doesn’t have enough serotonin.
Serotonin (also called '5HT') is a naturally-occurring chemical messenger (or “neurotransmitter”) that has an important role in areas of the brain that control mood and thinking.
Selective serotonin reuptake inhibitors (SSRIs) - like escitalopram - are thought to work by increasing levels of serotonin in the brain. They do this by blocking the recycling of released serotonin back into the nerve endings.
Escitalopram is often prescribed alongside a talking therapy.
How long does escitalopram take to start working?
It takes two to four weeks for escitalopram to show its full effect.
Scientists believe that when you first start taking escitalopram, the higher levels of serotonin have direct effects which might not relieve your depression. In fact, you are likely to feel a bit more anxious and ‘on edge’ for a couple of weeks. After this, adaptive changes take place in your brain that should lead to improvements in mood, helping to lift the depression.
Your doctor might start you on a low dose and then increase it slowly over two to four weeks to your full dose. They might also reduce your dose, depending on how it affects you.
How long will I need to take escitalopram?
Most people take escitalopram for at least six months after they feel well again. This is to help guard against symptoms returning.
You and your doctor should discuss how long you might expect to continue this medication before you start taking it.
Your doctor needs to know if...
You need to talk to your doctor or pharmacist before starting treatment with escitalopram if you have any of the following:
- liver disease
- kidney disease
- diabetes (you may need an adjustment of your antidiabetic therapy)
- epilepsy or a history of seizures or fits
- a bleeding problem, or bleeding in the stomach or gut
- mania or panic disorder
- low blood levels of sodium.
- electroconvulsive therapy (ECT)
- problems with your eyes, such as narrow-angle glaucoma (increased pressure in the eye)
- heart problems, or a heart attack
- a low resting heartrate and/or you know that you may have lost salt from your body as a result of long-lasting diarrhoea (loose poo) and vomiting (being sick) or using diuretics (water tablets)
- a fast or irregular heartbeat, fainting, collapsing or dizziness when you stand up
How can escitalopram be taken?
You can take escitalopram as tablets or drops.
Tablets are available in 5mg, 10mg and 20mg strengths.
Oral drops are also available (20mg per ml – five drops are like one 5mg tablet). The drops contain a small amount of alcohol and will stay fresh for eight weeks once opened (store them in a cool, dry place). After this, you need to get a new bottle and return any unused drops to the pharmacy. Do not pour them down the sink or toilet.
Drops can be mixed with water, orange juice or apple juice to make them easier to take.
You should only take escitalopram as agreed with your doctor.
To get the best effect from escitalopram, take it once a day, every day.
Make sure that you know your dose. If it is not written on the label, check with your pharmacist or doctor.
You can take it every morning, when you have breakfast or brush your teeth.
If you find that it makes you sleepy, you can take it at nighttime instead.
You can take it before or after food.
Swallow the tablets with a drink of water - if you chew them, they taste bitter.
What if I miss a dose?
If you forget to take a dose, take it as soon as possible after you remember.
If you forget to take it by bedtime, start again the next day.
Do not take a double dose.
What will happen if I forget to take my escitalopram?
If you forget to take it for a few days, you may start getting withdrawal symptoms. If you do, see your doctor as soon as possible.
Stopping the use of escitalopram
If you want to stop taking escitalopram, please speak to your doctor first. Stopping the medication causes the balance of chemicals in the brain to change, so it’s safer to reduce your dosage slowly over a few weeks, rather than stopping suddenly.
This does not mean you are addicted to the medicine - just that your brain has become accustomed to new levels of serotonin.
Some of the symptoms you might get include:
- dizziness or headaches
- numbness, ‘pins and needles’ or tingling in hands or feet
- sleep disturbances (vivid dreams, nightmares, not being able to sleep)
- burning or ‘electric shock’ feelings in the head, neck and down the spine (back)
- feeling anxious, confused or disorientated
- feeling or being sick or having diarrhoea (loose poo)
- sweating (including night sweats) or shaking
- feeling restless or agitated or feeling emotional or irritable
- flu-like symptoms
- tinnitus (ringing in your ears)
- problems with your eyes
- fluttering/pounding heartbeat (palpitations)
Withdrawal symptoms should stop within two weeks. If they do not, or they are preventing you from getting on with your life, speak to your doctor.
The information on this page was reviewed by the College of Mental Health Pharmacy in October 2019.