Understanding the Cause: Why Does Lexapro Cause Stomach Upset?
To understand why Lexapro (escitalopram) can cause an upset stomach, it helps to know how it works. Lexapro is a type of antidepressant known as a selective serotonin reuptake inhibitor (SSRI). It works by increasing the amount of serotonin available in the brain, which helps regulate mood. However, the human body produces about 90% of its serotonin in the gastrointestinal (GI) tract.
When you start taking Lexapro, the elevated serotonin levels don't just affect the brain; they impact the GI tract as well. This can disrupt normal digestive functioning, leading to a variety of symptoms that can feel like a mild stomach flu, including nausea, diarrhea, and indigestion. Your digestive system needs time to adjust to these altered serotonin levels, which is why these symptoms are most prominent when you first begin the medication.
The Typical Timeline: When to Expect Relief
For most individuals, the upset stomach associated with starting Lexapro is a short-term issue. The timeline typically follows a predictable pattern:
- First Few Days: Side effects like nausea and stomach discomfort often begin within the first few days of starting treatment. For some, symptoms may peak around the fifth day.
- One to Two Weeks: In most cases, mild symptoms begin to subside and clear up within one to two weeks as your body gets used to the medication. Taking the medication with food can be especially helpful during this initial phase.
- Beyond Four to Six Weeks: If your upset stomach and other GI issues persist beyond four to six weeks, it's important to contact your healthcare provider. Your doctor may need to adjust your dosage, or you may need to try an alternative medication. In some rarer cases, GI symptoms can persist for up to three months.
Managing Upset Stomach During Lexapro Adjustment
While waiting for your body to adjust, there are several practical strategies you can use to alleviate the discomfort of an upset stomach:
- Take it with food: The most common and effective tip is to take your Lexapro dose with food. This can help prevent stomach upset and is recommended by medical professionals.
- Eat smaller, more frequent meals: Instead of three large meals, try eating smaller portions more often throughout the day. This can reduce the burden on your digestive system.
- Avoid certain foods: Temporarily cutting back on spicy, fried, or fatty foods can help keep nausea at bay. Sticking to a bland diet, like the BRAT diet (bananas, rice, applesauce, and toast), can also help if you experience diarrhea.
- Consider taking your dose at night: If you primarily experience nausea, taking your dose in the evening before bed might allow you to sleep through the worst of the symptoms. Be sure to discuss this timing change with your doctor first, as it could affect your sleep patterns.
- Sip fluids and try ginger: Stay hydrated by sipping water or ginger ale throughout the day. Sucking on sugarless hard candy can also be helpful for nausea.
- Discuss OTC options: If needed, ask your doctor about over-the-counter (OTC) remedies like certain antacids or anti-nausea medication. It is crucial to get approval from your prescriber before taking any new medication to avoid interactions.
When to Seek Medical Attention for Stomach Issues
While an upset stomach from Lexapro is typically a benign, temporary side effect, it can sometimes be a sign of a more serious issue. It is crucial to be aware of the warning signs and to contact your doctor if your symptoms are severe, worsening, or include any of the following:
- Signs of Serotonin Syndrome: Although rare, an excessive buildup of serotonin can lead to a potentially life-threatening condition called Serotonin Syndrome. Symptoms include agitation, confusion, a rapid heart rate, high fever, sweating, muscle rigidity, and tremors. Seek emergency medical care immediately if these occur.
- Abnormal Bleeding: Lexapro can increase the risk of unusual bleeding, especially in the stomach. Seek immediate medical attention if you notice dark, tarry stools; blood in your stool; or blood in your vomit. The risk is higher if you are also taking blood thinners or NSAIDs.
- Low Sodium Levels (Hyponatremia): In rare cases, Lexapro can cause low sodium levels, particularly in the elderly. This can lead to symptoms like persistent headaches, confusion, muscle cramps, and weakness.
Comparison of Typical vs. Serious Gastrointestinal Symptoms
| Symptom Type | Typical Side Effects (Resolve in 1-2 weeks) | Signs of Serious Concern (Seek Immediate Care) |
|---|---|---|
| Nausea & Vomiting | Mild to moderate nausea, occasional vomiting. | Severe or uncontrollable vomiting, especially if accompanied by confusion, fever, or dizziness. |
| Stomach Pain | Mild indigestion or cramping. | Severe, sharp abdominal pain, particularly if accompanied by dark or bloody stools. |
| Diarrhea | Mild diarrhea, watery stools, increased frequency. | Severe, persistent diarrhea that leads to dehydration, especially if combined with other severe symptoms. |
| Bleeding | None | Dark or bloody stools, blood in vomit, unusual bruising or bleeding from gums. |
| Mental State | Mild nervousness or restlessness. | Severe confusion, agitation, hallucinations, or seizures. |
Conclusion
Experiencing an upset stomach is a very common and expected part of adjusting to Lexapro. The symptoms are typically mild and resolve on their own within one to two weeks as your body adapts to the medication. By taking simple steps like consuming your dose with food and managing your diet, you can significantly reduce the discomfort during this initial period. However, it is essential to be mindful of your body's signals and know the difference between standard adjustment side effects and more serious red flags, such as symptoms of Serotonin Syndrome or internal bleeding, which require immediate medical attention. If your upset stomach persists for longer than a month or if you experience any severe symptoms, it is crucial to consult your doctor for a reevaluation of your treatment plan. As mentioned by the Mayo Clinic, keeping your doctor informed about any persistent side effects is vital for managing your care effectively.
Disclaimer: This article is for informational purposes only and is not a substitute for professional medical advice. Always consult a healthcare professional for diagnosis and treatment.
Keypoints
- Common and Temporary: An upset stomach, nausea, and diarrhea are very common side effects when starting Lexapro, typically lasting one to two weeks.
- Serotonin's Role: The GI side effects are caused by the medication's effect on serotonin levels in the gut, which accounts for most of the body's serotonin.
- Take with Food: The most effective way to minimize stomach upset is by taking your Lexapro dose with a meal or snack.
- Monitor the Timeline: If GI symptoms persist beyond four to six weeks, a consultation with your doctor is recommended to discuss potential dose adjustments.
- Watch for Serious Symptoms: While rare, symptoms like severe confusion, rapid heartbeat, or bloody stools warrant immediate medical attention, as they could indicate a serious complication like Serotonin Syndrome or GI bleeding.
