Exploring What is the dark side of Lexapro?: Beyond the Mood Boost

October 10, 2025 •

4 min read

Over half of all patients on selective serotonin reuptake inhibitors (SSRIs) like Lexapro report sexual side effects, including low libido and difficulty with orgasm. This common issue is just one aspect of what constitutes the dark side of Lexapro, revealing that its effects extend beyond simply regulating mood.

Quick Summary

Lexapro's downsides include sexual dysfunction, emotional blunting, and withdrawal syndrome when discontinuing. Serious risks, such as suicidal ideation, serotonin syndrome, and hyponatremia, also exist. Managing these potential adverse effects requires careful consideration and medical supervision.

Key Points

Suicidal Risk: The FDA has issued a black box warning for Lexapro, highlighting an increased risk of suicidal thoughts and behaviors in young adults (under 25), especially during the first few months or with dosage adjustments.
Emotional Blunting: Many patients experience a flattening of emotions, feeling less reactive to both positive and negative stimuli, which can profoundly impact quality of life and sense of self.
Sexual Dysfunction: Persistent sexual side effects, including decreased libido, delayed or absent orgasm, and erectile dysfunction, are common and often do not resolve over time.
Withdrawal Syndrome: Abruptly stopping Lexapro can lead to Antidepressant Discontinuation Syndrome, causing challenging symptoms like 'brain zaps,' dizziness, mood swings, and insomnia.
Serious Health Complications: Though rare, Lexapro carries risks of serious conditions like life-threatening serotonin syndrome, manic episodes in individuals with bipolar disorder, and low sodium levels (hyponatremia).
Long-term Effects: Long-term use is associated with potential issues such as weight gain and dependence, requiring careful and medically supervised tapering.

While Lexapro (escitalopram) is a widely prescribed and often effective medication for treating major depressive disorder (MDD) and generalized anxiety disorder (GAD), its benefits are not without potential downsides. Many users encounter difficult side effects and long-term challenges that complicate their treatment and overall well-being. A critical examination of these adverse effects is essential for anyone considering or currently taking this medication.

The FDA's Black Box Warning and Suicidal Risk

One of the most serious and well-known risks associated with Lexapro is the FDA's black box warning for increased suicidal thoughts and behaviors. This is the most serious type of warning issued by the FDA and specifically highlights the risk in children, adolescents, and young adults (under 25). The risk is highest during the initial months of treatment or following dosage changes. While the benefit of treating depression can outweigh this risk for many, the potential for new or worsening depression, anxiety, agitation, and restlessness must be monitored closely by both the patient and their caregivers. Research suggests that for adults aged 65 and older, antidepressants may actually have a protective effect against suicidal thoughts.

Persistent and Unsettling Side Effects

Beyond the initial, temporary side effects like nausea and fatigue, many users report persistent and deeply personal adverse reactions. Two of the most commonly cited are emotional blunting and sexual dysfunction.

Emotional Blunting

Emotional blunting, or feeling emotionally numb, is a significant concern for many long-term SSRI users. Patients describe feeling detached from both negative and positive emotions. While this may dull the pain of depression, it can also diminish the capacity for joy, pleasure, and connection. This can be a terrifying experience, leading some to fear they have lost their sense of self or empathy. A 2023 study found that healthy participants taking escitalopram showed reduced reactivity to both positive and negative experiences, validating the blunting effect many users report.

Sexual Dysfunction

Sexual side effects are another prevalent issue, affecting more than half of patients taking SSRIs. These can include decreased libido, erectile dysfunction, delayed or absent ejaculation, and difficulty achieving orgasm. Unlike other initial side effects, sexual dysfunction often does not subside over time. This can put a significant strain on relationships and negatively impact a person's quality of life.

Other Common and Long-Term Effects

Weight Fluctuations: Some individuals experience weight gain due to increased appetite or changes in metabolism, which can exacerbate depressive feelings. Others may experience weight loss, particularly children and adolescents.
Sleep Disturbances: Lexapro can cause both insomnia and excessive sleepiness or fatigue, impacting daily functioning.
Increased Sweating: Many users report increased or excessive sweating as a persistent side effect.

Antidepressant Discontinuation Syndrome (ADS)

Ending Lexapro treatment can be a difficult process, and abruptly stopping the medication is strongly discouraged due to the risk of Antidepressant Discontinuation Syndrome (ADS). ADS is a collection of withdrawal symptoms that can be physically and psychologically challenging. The severity and duration of symptoms can vary widely depending on the dosage and length of use.

Common withdrawal symptoms include:

Sensory Disturbances: Often referred to as 'brain zaps' or tingling sensations.
Flu-like Symptoms: Including nausea, headaches, and fatigue.
Mood Swings: Anxiety, irritability, and a resurgence of depression.
Sleep Problems: Insomnia and vivid nightmares.
Cognitive Issues: Difficulty concentrating and memory problems.

To minimize these effects, healthcare providers recommend a gradual tapering schedule, where the dosage is slowly reduced over a period of weeks or months. Some individuals may experience protracted withdrawal symptoms (PAWS) that last for a prolonged time.

Rare but Serious Complications

While uncommon, certain severe health risks are associated with Lexapro and require immediate medical attention if they occur.

Serotonin Syndrome: A potentially life-threatening condition caused by an excess of serotonin in the body. This can occur with concomitant use of other serotonergic drugs, such as triptans, or St. John's Wort. Symptoms include agitation, hallucinations, a rapid heart rate, muscle rigidity, and fever.
Mania/Hypomania: In individuals with undiagnosed bipolar disorder, Lexapro can trigger a manic or hypomanic episode. This underscores the importance of screening for bipolar disorder before starting treatment.
Hyponatremia: Lexapro can lead to low sodium levels in the blood, particularly in elderly patients or those taking diuretics. Symptoms include headache, confusion, weakness, and unsteadiness.
Abnormal Bleeding: The medication can increase the risk of abnormal bleeding or bruising, especially when taken with blood thinners like NSAIDs or warfarin.

Lexapro vs. Other SSRIs: A Comparison of Side Effects

While many SSRIs share similar side effect profiles, there can be notable differences in their half-life and potency, which influence the patient experience.


Side Effect	Lexapro (Escitalopram)	Paxil (Paroxetine)	Zoloft (Sertraline)
Half-Life	Longer (27-32 hrs)	Shorter (21 hrs)	Moderate (26 hrs)
Discontinuation	Moderate risk of ADS, but tapering still crucial.	Higher risk of ADS due to shorter half-life.	Moderate risk of ADS.
Sexual Dysfunction	Common.	High incidence.	Common.
Emotional Blunting	Frequently reported.	Can occur.	Can occur.
Weight Gain	Possible long-term side effect.	Higher propensity for weight gain.	Possible.

Conclusion

While Lexapro has proven to be an effective treatment for many, the potential for significant and sometimes debilitating side effects warrants careful consideration. The existence of risks like the black box warning for suicidality, persistent sexual dysfunction and emotional blunting, and the challenges of withdrawal highlight the darker side of this common medication. Patients must have open and honest communication with their healthcare providers about both the benefits and risks. A collaborative approach, including a personalized tapering plan when discontinuing, is crucial for mitigating adverse effects and ensuring the best possible outcome for one's mental and physical health. Understanding these potential dangers is not meant to discourage treatment, but rather to empower patients to be informed participants in their own care. For more information on side effects and medication management, refer to resources such as the FDA's official drug label.

Frequently Asked Questions

Lexapro carries a black box warning from the FDA concerning the increased risk of suicidal thoughts and behaviors in children, adolescents, and young adults (up to age 24). This risk is most prevalent when starting the medication or changing the dosage.

Yes, many people experience long-term sexual side effects from Lexapro, including decreased libido and issues with arousal or orgasm. These symptoms often do not diminish over time, unlike some other initial side effects.

Emotional blunting is a reported side effect where people feel emotionally numb or detached. They may feel less intense emotions overall, experiencing less sadness but also less joy or pleasure.

Stopping Lexapro abruptly can cause Antidepressant Discontinuation Syndrome (ADS), with symptoms like 'brain zaps,' dizziness, nausea, headaches, and mood swings. A gradual, medically supervised tapering process is recommended to minimize withdrawal effects.

While not considered an addictive substance in the traditional sense, the body can become chemically dependent on Lexapro. Long-term users may experience withdrawal symptoms (ADS) when they stop, which can be challenging to manage without a controlled tapering plan.

Serotonin syndrome is a serious condition caused by an overabundance of serotonin. It can occur when Lexapro is combined with other drugs that increase serotonin, such as certain pain medications, triptans, or St. John's Wort. Symptoms include agitation, rapid heart rate, fever, and confusion.

Yes, in some cases, particularly during the early stages of treatment, Lexapro can paradoxically worsen depression or anxiety symptoms. It is critical for patients and caregivers to monitor for any worsening symptoms or unusual behavior.