Lexapro (escitalopram) is a common selective serotonin reuptake inhibitor (SSRI) used to treat major depressive disorder and generalized anxiety disorder. While it can be highly effective, not everyone responds to it, and some experience intolerable side effects. Navigating this is a vital part of finding the right mental health treatment. Below, we'll outline the key signs that Lexapro may not be the right choice for you.
What to Expect in the Initial Weeks
When you first begin taking Lexapro, your body needs time to adjust to the increased serotonin levels. It is normal to experience some mild, temporary side effects during the first one to two weeks, which typically lessen as your body acclimates. It's important to distinguish these initial adjustment effects from longer-term issues. Common early side effects include:
- Nausea
- Headaches
- Drowsiness or insomnia
- Increased sweating
- Increased anxiety (which should subside)
Give the medication a chance to work, which can take four to eight weeks to see the full therapeutic effects. If mild side effects persist beyond the initial phase or if you see no improvement, it's time to reassess with your doctor.
Key Indicators That Lexapro Is Not Working
After giving Lexapro a full trial period of six to eight weeks, certain indicators suggest the medication is not an effective treatment for you. This is different from the initial adjustment period and signals a need for a change in strategy.
Lack of Symptom Improvement
- Persistent Depression or Anxiety: If your depressive symptoms (e.g., low mood, hopelessness, loss of interest) or anxiety symptoms (e.g., excessive worry, restlessness) do not improve noticeably after two months, the medication may be ineffective.
- Partial Response: Some people may feel slightly better, but their symptoms remain severe enough to interfere with daily life and functioning. This partial response indicates that a different medication or an adjusted approach might yield better results.
- Return of Symptoms: For those who initially felt better, a gradual return of depression or anxiety symptoms suggests a potential issue. The medication's effectiveness may have decreased over time, a phenomenon known as tachyphylaxis.
Persistent and Intolerable Side Effects
While some side effects are manageable, others can significantly impact your quality of life. If these effects don't subside after the initial weeks, Lexapro may not be the right fit.
- Significant Sexual Dysfunction: Common sexual side effects include decreased libido, delayed ejaculation, and difficulty achieving orgasm. If these are persistent and distressing, they can warrant a change in medication.
- Excessive Fatigue or Drowsiness: Feeling constantly tired or foggy can make it hard to function at work or school, negating the medication's benefits.
- Weight Changes: Unwanted weight gain or loss can be a side effect. Some people experience a decreased appetite initially, while others experience weight gain with long-term use.
When Lexapro Worsens Your Mental Health
In some cases, Lexapro can make existing symptoms worse or trigger new, dangerous ones. These scenarios require immediate medical attention.
Increased Anxiety, Agitation, or Irritability
For some, Lexapro can heighten feelings of agitation, restlessness, or irritability. If you experience new or worsening anxiety or panic attacks, especially during the first few months or after a dose change, contact your doctor.
The Risk of Mania
In individuals with undiagnosed bipolar disorder, taking an SSRI like Lexapro alone can trigger a manic or hypomanic episode. If you experience a period of elevated mood, racing thoughts, increased energy, and decreased need for sleep, contact your healthcare provider immediately.
Suicidal Thoughts and Behaviors
There is a boxed warning for increased risk of suicidal thoughts and behavior, particularly in adolescents and young adults. If you or a loved one experience new or worsening depression, anxiety, agitation, or any suicidal ideation, seek emergency medical help immediately.
The Lexapro 'Poop-Out' Effect (Tachyphylaxis)
For some individuals, an antidepressant that initially worked well can become less effective over time. This can occur due to various factors, including the body building a tolerance to the medication or changes in life circumstances and stress levels. If your symptoms return after a period of stability, discuss this possibility with your doctor. The solution may involve adjusting the dose or switching to a different medication.
Serious and Rare Warning Signs
Certain severe side effects are rare but require urgent medical care.
- Serotonin Syndrome: This life-threatening condition is caused by an excess of serotonin. Symptoms include agitation, confusion, fever, rapid heart rate, and stiff muscles. It can occur when Lexapro is combined with other medications that increase serotonin.
- Hyponatremia (Low Sodium): This is more common in older adults and can cause headaches, confusion, weakness, and unsteadiness.
- Increased Bleeding: Lexapro can increase the risk of unusual bleeding or bruising, especially when taken with NSAIDs or blood thinners.
Comparison of Lexapro and Alternatives
When Lexapro isn't the right fit, other options are available. Discussing alternatives with your doctor is the next step.
| Medication Class | Example Medications | How They Work | Typical Use | Sexual Side Effects | Other Notable Side Effects |
|---|---|---|---|---|---|
| SSRI | Lexapro (escitalopram), Zoloft (sertraline) | Increases serotonin levels | Depression, Anxiety, OCD, Panic Disorder | Common (reduced libido, orgasm issues) | Nausea, insomnia, weight changes |
| SNRI | Effexor XR (venlafaxine), Cymbalta (duloxetine) | Increases serotonin and norepinephrine | Depression, Anxiety, Pain conditions (e.g., Cymbalta) | Common (similar to SSRIs) | Nausea, fatigue, dry mouth |
| Atypical | Wellbutrin (bupropion) | Affects dopamine and norepinephrine | Depression, Seasonal Affective Disorder | Lower risk compared to SSRIs/SNRIs | Insomnia, dry mouth, constipation |
| Atypical | Remeron (mirtazapine) | Affects serotonin and norepinephrine | Depression, often for insomnia/appetite issues | Lower risk compared to SSRIs/SNRIs | Sleepiness, increased appetite, weight gain |
What to Do If Lexapro Is Not Right for You
If you believe Lexapro is not working or is causing unacceptable side effects, follow these steps:
- Consult Your Healthcare Provider: Never stop taking Lexapro abruptly. Suddenly discontinuing the medication can cause withdrawal symptoms, such as dizziness, anxiety, irritability, and insomnia, a condition known as Antidepressant Discontinuation Syndrome. Your doctor will guide you on how to taper off the dose safely.
- Explore Other Medications: Your doctor may recommend switching to another SSRI, an SNRI, or an atypical antidepressant based on your symptoms and side effects.
- Consider Other Treatments: For some, psychotherapy, like Cognitive Behavioral Therapy (CBT), can be used alone or in combination with medication for better outcomes.
- Manage Lifestyle Factors: Ensure you are getting enough sleep, maintaining a healthy diet, and exercising. Stressful situations can also impact your mental health, even while on medication.
Conclusion
While Lexapro can be a valuable treatment, it is not the right medication for everyone. Recognizing the signs that it may not be working—including a lack of improvement after sufficient time, persistent intolerable side effects, or a worsening of your condition—is crucial. Communication with your doctor is key to a safe and effective treatment plan. If you suspect Lexapro is not for you, work with your healthcare provider to explore alternative medications or therapeutic strategies to help you on your path to better mental health.
For more information on Lexapro and other antidepressants, consider reliable resources such as the U.S. National Library of Medicine or the National Alliance on Mental Illness (NAMI).
