Understanding Lexapro and Its Side Effects
Lexapro, with the generic name escitalopram, is a widely prescribed antidepressant belonging to the class of drugs known as selective serotonin reuptake inhibitors (SSRIs) [1.7.5]. It is approved for the treatment of Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD) [1.8.5]. Lexapro works by increasing the levels of serotonin, a neurotransmitter in the brain, which helps to improve mood [1.7.5]. While effective, like all medications, it can cause side effects. Gastrointestinal issues, including nausea and diarrhea, are among the most common, especially when first starting the medication [1.7.1, 1.4.4].
Why Does Lexapro Cause Diarrhea?
The primary mechanism behind Lexapro-induced diarrhea is related to its effect on serotonin. While often thought of as a brain chemical, a large amount of serotonin is also found and utilized in the gastrointestinal (GI) tract [1.8.1]. SSRIs like escitalopram increase serotonin levels not just in the brain but throughout the body. In the gut, increased serotonin can stimulate 5-HT3 receptors, which accelerates intestinal motility and can alter fluid balance in the digestive system [1.6.1, 1.6.2]. This increased movement and fluid can lead to looser, more frequent stools, or diarrhea [1.6.2]. In some instances, SSRI use has also been linked to microscopic colitis, a type of inflammation in the colon, though the exact link is still being researched [1.6.2, 1.6.4].
Typical Duration of Diarrhea
For most individuals, diarrhea as a side effect of Lexapro is a temporary issue that occurs during the initial phase of treatment. The body generally needs a few days to a couple of weeks to adjust to the medication [1.2.3, 1.2.1]. Many users find that this side effect improves and resolves on its own within the first week or two [1.2.1, 1.7.3].
However, the duration can vary. Some sources suggest that if side effects persist beyond four to six weeks, a consultation with a healthcare provider is necessary, as a dose adjustment may be required [1.7.1, 1.4.4]. While less common, it is also possible for diarrhea to persist in some patients for a longer period [1.2.4, 1.2.6]. Data from one study indicated that while 78% of patients on SSRIs who experienced diarrhea had it within the first two weeks, 45% of them still had the side effect at the three-month mark [1.2.4, 1.3.6]. The incidence of diarrhea can also be dose-dependent; one study noted that at a 10mg/day dose of Lexapro, the rate of diarrhea was 6%, but it increased to 14% at a 20mg/day dose [1.3.1].
How to Manage Diarrhea from Lexapro
If you are experiencing diarrhea, there are several strategies you can employ to manage the symptoms:
- Stay Hydrated: Diarrhea can lead to dehydration, so it's crucial to drink plenty of fluids like water or clear broths [1.2.2, 1.4.2].
- Adjust Your Diet: Stick to bland foods for a few days. The BRAT diet (bananas, rice, applesauce, toast) is often recommended. Foods like potatoes, steamed chicken, and pasta can also be gentle on the stomach [1.4.6, 1.2.5]. Avoid fried, greasy, rich, or spicy foods [1.4.5, 1.2.5].
- Take Lexapro with Food: Taking your dose with a meal can sometimes lessen gastrointestinal side effects [1.4.3, 1.4.5].
- Consider Probiotics: Some evidence suggests probiotics might help restore gut balance, but you should consult your doctor before starting any new supplement [1.2.2].
- Over-the-Counter (OTC) Medication: Your healthcare provider may recommend an OTC antidiarrheal medication like loperamide (Imodium) for temporary relief. It's important to use these only with medical guidance [1.2.5, 1.4.2].
Comparison of GI Side Effects in Common SSRIs
Gastrointestinal side effects are common across the SSRI class, but their incidence can vary between different medications.
| Antidepressant (SSRI) | Common GI Side Effects | Notes on Diarrhea Incidence |
|---|---|---|
| Escitalopram (Lexapro) | Nausea, Diarrhea, Constipation, Indigestion [1.3.1] | Diarrhea occurs in about 8-14% of users, depending on the dose [1.3.1]. Generally considered to have better GI tolerability than paroxetine and sertraline [1.5.1]. |
| Sertraline (Zoloft) | Nausea, Diarrhea [1.5.2] | Associated with a higher incidence of diarrhea compared to other SSRIs, with some studies showing rates around 14% versus 7% for other SSRIs [1.5.4, 1.3.4]. |
| Fluoxetine (Prozac) | Nausea, Diarrhea, Anorexia [1.5.2] | Has been associated with a lower probability of digestive side effects compared to other SSRIs in some analyses [1.5.1]. |
| Paroxetine (Paxil) | Nausea, Constipation [1.2.4, 1.6.3] | Has a higher rate of constipation compared to other SSRIs but a lower incidence of diarrhea (around 8%) [1.5.4, 1.2.4]. |
| Citalopram (Celexa) | Nausea, Diarrhea [1.6.1] | As the parent compound of escitalopram, it has a similar side effect profile. Some studies suggest sertraline has a higher rate of diarrhea than citalopram [1.4.1]. |
When to Contact a Doctor
While mild diarrhea is a common and often transient side effect, you should contact your doctor if:
- Side effects persist for more than a few weeks [1.7.1].
- Diarrhea is severe or does not improve with dietary changes [1.2.5].
- You experience signs of dehydration, such as dizziness or reduced urination [1.2.5].
- You notice blood in your stool, black or red stools, or have significant abdominal pain [1.4.1, 1.7.2].
- The diarrhea is accompanied by other concerning symptoms like high fever, agitation, confusion, rapid heartbeat, or muscle rigidity. These could be signs of a rare but serious condition called serotonin syndrome [1.2.1, 1.6.5, 1.7.2].
It's crucial to never adjust your dose or stop taking Lexapro abruptly without consulting your healthcare provider, as this can lead to withdrawal symptoms [1.7.3].
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a qualified healthcare professional before making any decisions about your medication. For immediate support, you can contact the 988 Suicide & Crisis Lifeline by calling or texting 988 in the US and Canada [1.7.1].
