Escitalopram

Medication name

Escitalopram ("Essit-AL-o-pram")
Brand name

Cipralex™ ("SIP-ra-lex")
Medication type

Selective serotonin reuptake inhibitor (SSRI)
Ways to take it

Tablets: 5mg, 10mg and 20mg strengths
Oral drops: 20mg per ml (five drops are like one 5mg tablet)

If you are 18 or over, the doctor can prescribe escitalopram for you as a licensed medicine for depression (low mood) or a number of anxiety disorders.

There is less research about its use and effectiveness in people under 18. Even so, specialists might prescribe it ‘off-label’ if they believe it is the best medicine for you.

Read our guide to depression

About escitalopram

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.

Escitalopram and everyday life

Frequently asked questions

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.

It is difficult to know how escitalopram will affect each person who takes it.

Talk to your doctor about this if it worries you.

You may want to let your family and friends know you are taking escitalopram so they can support you and help you look out for side effects.

For guidance on this, check out our page on getting support with your medication.

You can feel tired in the first few days of taking escitalopram. However, this should get better after the first week or two.

If you feel like a zombie, and you’ve been taking it for more than a month, you should go back to the doctor and see what else you could try.

Alcohol

You can continue to drink alcohol in moderation while taking escitalopram. However, the two together might make you feel very sleepy, especially when you first start taking the medication.

During the first few weeks of treatment, it might be best to stop drinking alcohol until you see how the medicine affects you.

Street drugs

Cannabis can give you a fast heartbeat if taken alongside escitalopram.

Cannabis and other drugs may have their own side effects on your mental health, like anxiety or psychosis. For more information, have a look at our drugs and alcohol page.

Methadone can make drowsiness worse with escitalopram. The escitalopram could increase the concentration of methadone in your body.

Escitalopram could raise the level of cocaine in your body, giving you a bigger reaction.

Taking escitalopram with cocaine, ecstasy or amfetamines could bring on serotonin syndrome. You could get a high temperature/fever, agitation, confusion, trembling or weird muscle movements. You need to go to hospital if this happens, taking your escitalopram with you.

Escitalopram does not mix well with some other medicines and drugs. Do not take escitalopram if you have taken a monoamine oxidase inhibitor antidepressant (MAOI) like moclobemide, phenelzine, isocarboxazid or tranylcypromine in the last 14 days.

Do not take escitalopram with the herbal product St. John’s Wort.

Before you start taking escitalopram, tell your doctor if you are taking any other medications including things you have bought over the counter for common illnesses like colds and flu or topical applications that you put on your skin.

Taking escitalopram may affect your ability to do things like driving a car, riding a bike, or anything else that needs a lot of focus or balance. It can make you tremble, or feel dizzy or restless. It might be best to stop doing things like driving or riding a bike for the first few days, until you know how it affects you.

Do not worry - most people drive and do other things as normal while taking escitalopram.

Pregnancy

Risks with escitalopram in pregnancy are low but women who are trying to get pregnant should talk about it with their doctor.

If you do become pregnant while you are on escitalopram, you should carry on taking the medicine and go back to your doctor as soon as possible to discuss your options.

If you decide to carry on taking escitalopram, you should tell your midwife that you are taking it before you give birth.

Post-natal

If escitalopram is taken in the last five months of a pregnancy, it can cause a serious condition called persistent pulmonary hypertension of the new-born (PPHN). This can make the baby breathe faster and look a bit blue in colour. PPHN affects around three in 1,000 babies born to mums who take SSRIs. This compares with a rate of two in 1,000 among babies born to mums who do not take SSRIs.

PPHN appears in the first 24 hours after birth. You will need help from the midwife and doctors, so it is better if they are looking out for symptoms.

There are some other symptoms that can occur in newborn babies if escitalopram is taken in the last three months of pregnancy, so do look out for these and get help if they happen:

fits or shaking
being too hot or cold
feeding difficulties or being sick
having stiff or floppy muscles, or overactive reflexes
being jittery, irritable or having constant crying
being very sleepy or finding it difficult to sleep

These are usually mild and go away in a few days without treatment.

Breastfeeding

Escitalopram passes to the baby in breast milk in small amounts.

Breastfeeding may help offset any withdrawal symptoms.

Please talk to your midwife, doctor or pharmacist if you want to breastfeed while taking escitalopram.

Sex

Escitalopram can have side effects that might affect your sex life. These include:

painful erections or problems getting an erection and ejaculating (coming)
bleeding from the vagina and difficulty reaching orgasm (coming) the same way as before
lower sex drive

The good effects of escitalopram may, after a while, have a positive effect on your sex life as your mood lifts and you become interested in life and relationships again.

Fertility

There is nothing to suggest that escitalopram affects fertility.

Escitalopram is not a banned substance in sport.

Taking escitalopram may affect doing things like riding a bike, competitive gymnastics, or anything else that needs a lot of focus and balance.

It might be best to stop such sports for the first few days, until you know how it affects you.

Do not worry - most people play sports as normal while taking escitalopram.

Try not to take escitalopram for the first time just before your exams.

Taking escitalopram may affect your sleep and make you feel restless, which might interfere with your preparation for exams.

You should talk to your doctor about any future exams if you are starting escitalopram.

You might decide together to delay starting it until you have done them. If they are more than a month away, however, you might find that it is better to start escitalopram to lift your mood and improve your motivation to study.

Do not worry - most people take exams as normal while taking escitalopram.

Your doctor should know

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.
ongoing electroconvulsive therapy (ECT)
problems with your eyes, such as narrow-angle glaucoma (increased pressure in the eye)
heart problems, or a heart attack
a fast or irregular heartbeat, fainting, collapsing or dizziness when you stand up

Uses, warnings, safety and side effects of escitalopram

Taking escitalopram

How long will I need to take escitalopram for?

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.

You should only take escitalopram as agreed with your doctor

To get the best effect from escitalopram, take it once a day, every day. You can take it every morning, when you have breakfast or brush your teeth.

Make sure that you know your dose. If it is not written on the label, check with your pharmacist or doctor.

If you find that it makes you sleepy, you can take it at night 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 should I do if I miss a dose of escitalopram?

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.

Warnings and safety

Safety headlines

If you have taken more escitalopram than the dosage recommended by the doctor who prescribed it to you, you must get medical help immediately – even if you do not feel any different.

As part of depression, some people think about hurting themselves or taking their own lives. Taking an antidepressant may not stop this. You must get some urgent help if you are having these sorts of thoughts. Speak to someone who is looking after you or go straight to hospital with your tablets.

Escitalopram can cause serious side effects like allergic reactions (difficulty breathing, swelling of your face or throat, itching skin lumps). Go to a hospital if you get any of these symptoms, taking your medicine with you.

Young people under 25 have an increased risk of trying to take their own lives, thinking about taking their own lives, and hostility (mostly aggression, oppositional behaviour and anger) when they take escitalopram. Therefore, it is not licensed for people under 18 years.

If you are under 18, you may still be prescribed escitalopram if you and your doctor have decided that the benefits outweigh the risks for you. Make sure that you have planned what to do if you experience any side effects from taking escitalopram and ask family and friends to support you during your treatment.

Stopping escitalopram suddenly can cause unpleasant withdrawal effects. Go to your doctor if you want to stop, or if you are having these effects.

You might feel sleepy in the first few days after taking escitalopram. Do not drive a car, ride a bike or operate machines until you see how this affects you.

If you take escitalopram while you are pregnant, it is unlikely to affect the developing baby.

Escitalopram sometimes causes symptoms in newborn babies that affect their breathing. Talk to your doctor and midwife so that your baby can be closely monitored after birth.

In most cases you should be able to breastfeed as normal.

When to go to the hospital

If you have taken more escitalopram than the dosage recommended by the doctor who prescribed it to you, you must get medical help immediately – even if you do not feel any different. Go to A&E, and take your medicine with you to show to the doctors. Tell them how much you have taken. Get a friend or family member to go with you if you can, just in case you feel ill on the way.

You might get any of the following signs:

changes in your heartbeat - it may start going fast or unevenly
nausea (feeling sick) or being sick
having a seizure/convulsion (fit)
sweating
feeling sleepy
passing out
feeling shaky (tremor) or dizzy
changing blood pressure, where you feel dizzy if you stand up
feeling agitated
going into a coma
you are also at risk of getting serotonin syndrome. Symptoms include fever, agitation, confusion, trembling, or weird movements of your muscles. This is rare, but you should watch out for it and go straight to A&E if you experience these side effects

Stop taking escitalopram and go to a doctor or hospital straight away if you get any of the following symptoms:

difficulty breathing
swelling of your face, lips, tongue or throat to the extent that you cannot swallow or breathe
severe itching of the skin (with raised lumps)
difficulty urinating (going for a pee)
jaundice (yellowing of the skin and the whites of the eyes)
fast, uneven heartbeat and fainting - these could be signs of a life-threatening condition called torsades de pointes

Go to a doctor or hospital straight away, but do not stop your escitalopram, if you get any of the following symptoms:

you start having seizures (fits) for the first time, or if fits that you have had in the past happen more often
your behaviour changes because you feel very happy or over-excited
any unusual bleeding, including blood in your poo
tiredness, confusion and muscle twitching. You may have a low blood level of sodium
restlessness, or difficulty sitting or standing still
dizziness, feeling sick or being sick

Side effects of escitalopram

Escitalopram has fewer side effects than many other medicines used for depression, but if they occur, they can be serious.

Most side effects that appear should get better after a few days. If they do not, you should go back to your doctor. If you get any side effects not listed here, please look at the patient leaflet in the medicine pack.

Do not stop taking the tablets until you talk to your doctor, or you may get withdrawal symptoms as well.

Very common side effects of taking escitalopram (affecting more than one in ten people) include:

feeling sick
headache

Common side effects of taking escitalopram (affecting up to one in ten people) include:

strange dreams, difficulty going to sleep
feeling very tired or sleepy
unusual yawning
feeling anxious or restless
tingling or numbness in the hands or feet
tremor (shaking)
skin feeling prickly
weight gain
changes in appetite
diarrhoea or constipation
being sick
dry mouth
fever and increased sweating
pain in muscles and joints
blocked or runny nose (sinusitis)
lower sex drive, difficulty reaching orgasm, difficulty getting an erection

If you do get a side effect, please think about reporting it via the Yellow Card Scheme.