Lexapro, the brand name for escitalopram, is a selective serotonin reuptake inhibitor (SSRI) commonly prescribed for major depressive disorder (MDD) and generalized anxiety disorder (GAD) [1.4.1, 1.8.2]. It works by increasing the levels of serotonin, a natural substance in the brain that helps maintain mental balance [1.9.4, 1.9.5]. While many people find relief with this medication, a common concern is the initial experience. For many, the answer to 'Does Lexapro make you feel bad at first?' is yes, but this phase is usually short-lived [1.3.5].
Why Initial Side Effects Occur: The Adjustment Period
When you begin taking an SSRI like Lexapro, your brain and body need time to adjust to the changes in serotonin levels [1.5.2]. Serotonin isn't just in the brain; approximately 90% is found in the gastrointestinal (GI) tract [1.4.1]. This is why many initial side effects are GI-related, like nausea. The medication begins to build up in your system, which can trigger these temporary unwanted effects [1.3.2]. Most common side effects appear within the first one to two weeks of treatment and then decrease in intensity and frequency as your body adapts [1.5.6]. It can take four to six weeks to experience the full therapeutic benefits of the medication [1.5.2].
Common Initial Side Effects
During the first week or two, you may experience a range of mild to moderate side effects. These occur as your body gets used to the medication [1.3.2].
- Nausea: One of the most frequent side effects, occurring in 15% to 18% of patients in clinical trials [1.2.2, 1.2.6].
- Headache: A common complaint, especially when starting the medication [1.4.6].
- Sleep Disturbances: This can manifest as either trouble sleeping (insomnia) or feeling drowsy and fatigued [1.3.2, 1.4.1]. In studies, insomnia affected 9-12% of users, while somnolence (drowsiness) affected 6-13% [1.2.2].
- Dry Mouth: A frequent complaint that can be uncomfortable [1.4.6].
- Increased Sweating: About 5% of users report an increase in perspiration [1.2.2].
- Dizziness: Feeling dizzy or shaky is possible as you adjust [1.3.5].
- Diarrhea or Constipation: Your digestive system may be affected in the initial stages [1.3.2].
Strategies for Managing Early Side Effects
Fortunately, there are several ways to manage these initial symptoms and make the adjustment period more comfortable [1.6.1, 1.6.2].
- Be Patient and Consistent: Take your medication at the same time each day as prescribed. It can take several weeks to feel the full benefits [1.3.3].
- Manage Nausea: Take Lexapro with a small amount of food, like crackers, to reduce stomach upset. Eating smaller, more frequent meals and avoiding spicy or rich foods can also help [1.6.2, 1.6.4].
- Combat Sleep Issues: If Lexapro causes insomnia, try taking it in the morning. If it makes you drowsy, taking it at bedtime may be a better option [1.6.4]. Establishing a good sleep routine is also beneficial [1.6.1].
- Stay Hydrated: For dry mouth, sip water throughout the day, chew sugar-free gum, or suck on sugarless hard candy [1.6.2].
- Exercise: Gentle physical activity can help alleviate fatigue and improve your mood [1.6.1].
- Avoid Alcohol: Alcohol can increase drowsiness and may worsen side effects [1.6.2].
Lexapro vs. Other SSRIs: A Brief Comparison
Lexapro and Zoloft (sertraline) are both popular SSRIs, but they have slight differences in their side effect profiles.
| Feature | Lexapro (Escitalopram) | Zoloft (Sertraline) |
|---|---|---|
| Common Side Effects | Nausea, insomnia, fatigue, increased sweating, sexual dysfunction [1.4.1] | Nausea, diarrhea, insomnia, dry mouth, tremor, sexual dysfunction [1.7.2, 1.7.3] |
| Gastrointestinal Issues | Tends to cause less nausea than Zoloft (15% vs 26%) [1.7.4] | More likely to cause diarrhea than Lexapro [1.7.5]. |
| Drowsiness | Can cause drowsiness or fatigue [1.2.2]. | Can cause sleepiness [1.7.3]. |
| FDA-Approved Uses | Major Depressive Disorder (MDD), Generalized Anxiety Disorder (GAD) [1.7.4] | MDD, OCD, PTSD, Panic Disorder, Social Anxiety Disorder, PMDD [1.7.4] |
When to Contact Your Doctor
While most initial side effects are mild and transient, you should contact your healthcare provider if they are severe, persistent beyond a few weeks, or significantly impact your daily life [1.5.5, 1.8.3].
Seek immediate medical attention if you experience any serious symptoms, including:
- Suicidal thoughts or behaviors: All antidepressants have a boxed warning for an increased risk of suicidal thinking, especially in people 24 and younger [1.4.2, 1.8.4].
- Symptoms of Serotonin Syndrome: This rare but serious condition includes agitation, hallucinations, rapid heartbeat, fever, muscle stiffness, and confusion [1.8.1].
- Allergic Reaction: Signs include rash, hives, swelling of the face, lips, or tongue, and difficulty breathing [1.8.1].
- Signs of Mania: Such as racing thoughts, unusual risk-taking behavior, and extreme happiness or irritability [1.8.5].
- Seizures [1.8.1].
- Unusual bleeding or bruising [1.8.3].
Conclusion
Starting Lexapro often involves an adjustment period where you might feel worse before you feel better. Common initial side effects like nausea, headache, and fatigue are typically temporary and resolve within a couple of weeks as your body adapts [1.3.5, 1.5.4]. By using simple coping strategies and maintaining open communication with your healthcare provider, you can navigate this initial phase. Never stop taking your medication abruptly or change your dose without consulting your doctor, as this can lead to withdrawal symptoms [1.3.2].
For more information from a trusted source, you can visit the National Institute of Mental Health (NIMH) page on Mental Health Medications.
