What is Lexapro (Escitalopram)?
Lexapro, the brand name for escitalopram, is a widely prescribed antidepressant [1.2.1]. It belongs to a class of drugs called Selective Serotonin Reuptake Inhibitors (SSRIs). Its primary function is to increase the levels of serotonin, a neurotransmitter, in the brain, which helps to alleviate symptoms of major depressive disorder (MDD) and generalized anxiety disorder (GAD) [1.2.1, 1.5.2]. While its main target is the central nervous system, its mechanism of action has significant effects on other parts of the body, most notably the gastrointestinal (GI) tract [1.8.1].
The Gut-Brain Connection: Why GI Issues Occur
A common question for new users is, "Does Lexapro cause GI issues?" The answer lies in the role of serotonin outside the brain. A large number of serotonin receptors are located in the digestive system, where they help regulate gut motility and function [1.8.1]. By increasing overall serotonin levels, Lexapro can disrupt this delicate balance, leading to a range of digestive side effects [1.3.2, 1.4.5]. These effects are a direct result of the medication's therapeutic action and are often most pronounced during the first one to two weeks of treatment as the body adjusts [1.3.3, 1.3.2].
Common Gastrointestinal Side Effects of Lexapro
Gastrointestinal issues are among the most frequently reported side effects when starting Lexapro [1.2.1]. While they are typically mild and transient, they can be uncomfortable.
Most Prevalent GI Issues
- Nausea: This is one of the most common side effects, affecting nearly 20% of users in some clinical trials [1.4.1]. It usually begins early in treatment and subsides as the body adapts [1.4.3].
- Diarrhea: In clinical studies for Major Depressive Disorder, diarrhea occurred in 8% of patients taking Lexapro, compared to 5% on a placebo [1.9.3].
- Constipation: While diarrhea is more common, constipation can also occur as Lexapro disrupts normal digestive functioning [1.8.1, 1.3.3].
- Dry Mouth (Xerostomia): A very common side effect that can contribute to a feeling of general discomfort [1.3.3]. Chewing sugar-free gum can help manage this [1.4.4].
- Indigestion and Stomach Pain: Some individuals may experience indigestion, heartburn, abdominal pain, flatulence, and bloating [1.3.3, 1.8.2].
Managing and Mitigating GI Side Effects
Fortunately, there are several effective strategies to manage stomach problems associated with Lexapro. Most of these side effects decrease in intensity and frequency with continued treatment [1.3.3].
- Take with Food: Taking your dose with a meal can help buffer the stomach and reduce nausea [1.4.1, 1.7.2].
- Start Low, Go Slow: Doctors often initiate treatment at a low dose (e.g., 5mg) and gradually increase it, allowing the body to adjust more gently [1.4.5].
- Adjust Your Diet: If experiencing nausea, avoid rich, spicy, or fatty foods [1.4.4]. For diarrhea, a temporary bland diet may be beneficial [1.9.1]. For constipation, increasing intake of water and high-fiber foods is recommended [1.4.3].
- Stay Hydrated: Drinking plenty of fluids, especially water, is important, particularly if you are experiencing diarrhea or constipation [1.4.3, 1.9.4].
- Time Your Dose: If Lexapro causes drowsiness, taking it in the evening might be helpful. Conversely, if it causes insomnia, taking it in the morning is a better option [1.4.4].
Lexapro vs. Other Antidepressants: GI Side Effect Comparison
All SSRIs can cause GI upset, but some may be better tolerated than others [1.2.4].
| Medication | Class | Common GI Side Effects | Notes on GI Tolerability |
|---|---|---|---|
| Lexapro (Escitalopram) | SSRI | Nausea, diarrhea, constipation, dry mouth [1.3.3] | Generally considered well-tolerated. Nausea incidence is around 15-21% [1.6.2, 1.2.3]. May be less likely to cause nausea than some other SSRIs [1.6.4]. |
| Zoloft (Sertraline) | SSRI | Nausea, diarrhea, indigestion [1.6.1] | Tends to cause more GI upset than Lexapro initially, with a nausea rate of about 26% [1.6.2]. One study found it had the highest probability of digestive side effects among SSRIs [1.6.5]. |
| Prozac (Fluoxetine) | SSRI | Nausea, dry mouth, diarrhea | One analysis suggested fluoxetine had the lowest probability of causing digestive side effects compared to other SSRIs [1.6.5]. |
| Cymbalta (Duloxetine) | SNRI | Nausea, constipation, dry mouth, decreased appetite | As a Serotonin-Norepinephrine Reuptake Inhibitor (SNRI), it also affects serotonin and can cause similar GI issues. |
When to Contact a Doctor
Most GI side effects resolve within the first few weeks of treatment [1.7.4]. However, you should contact your healthcare provider if side effects are severe, persist beyond four to six weeks, or worsen over time [1.7.1]. Seek immediate medical attention for serious symptoms such as:
- Severe or continuous vomiting or diarrhea [1.9.1]
- Signs of gastrointestinal bleeding, such as black, tarry stools or vomiting blood [1.3.3, 1.3.5]
- Severe abdominal pain [1.3.3]
- Signs of serotonin syndrome, which can include diarrhea along with agitation, fever, and muscle twitching [1.3.2]
Conclusion
So, does Lexapro cause GI issues? Yes, it is a very common and well-documented occurrence, primarily due to the medication's effect on serotonin receptors in the gut [1.4.5, 1.8.1]. For most people, symptoms like nausea and diarrhea are mild and temporary, resolving within a few weeks as the body adapts [1.7.3]. By using simple management strategies, such as taking the medication with food and making dietary adjustments, most patients can tolerate these initial side effects. Always maintain open communication with your healthcare provider to ensure your treatment plan is both safe and effective.
For more detailed information, you can review the official FDA medication label for Escitalopram: https://www.accessdata.fda.gov/drugsatfda_docs/label/2003/21323se1-003,se8-007,21365se8-001,se1-004_lexapro_lbl.pdf [1.5.2]
