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) [1.3.4]. It works by increasing the levels of serotonin, a neurotransmitter in the brain that helps regulate mood [1.2.5]. While effective, starting any new medication can come with an adjustment period, and it's quite normal to feel a bit 'weird' or different when you first begin taking Lexapro [1.2.1].
The Initial Adjustment Period: The First Few Weeks
When you start taking Lexapro, your body needs time to get used to the changes in serotonin levels. This adjustment phase is when most people experience side effects. These effects are typically most noticeable during the first one to two weeks of treatment and often decrease in intensity as your body adapts [1.8.4].
Some of the most common feelings and side effects during this initial period include:
- Gastrointestinal Issues: Nausea is one of the most frequently reported side effects, affecting nearly 20% of people in some studies [1.2.3]. Diarrhea, constipation, and stomach pain are also common [1.2.3].
- Sleep Disturbances: You might experience insomnia (trouble sleeping) or drowsiness and fatigue [1.2.1, 1.2.4]. Some people report having unusual or vivid dreams [1.2.6].
- Neurological and Emotional Sensations: Headaches, dizziness, and increased sweating are very common [1.3.3]. Paradoxically, some people might feel a temporary increase in anxiety, nervousness, or restlessness as their brain adjusts [1.4.1].
- Other Physical Effects: Dry mouth, changes in appetite, and sexual side effects like decreased libido are also possible [1.2.2, 1.2.3].
Most of these initial side effects are mild and transient. They generally resolve within a few weeks to a month [1.2.1]. It can take four to six weeks, or sometimes longer, to feel the full therapeutic benefits of the medication on your mood and anxiety levels [1.4.2, 1.4.4].
Managing Common Side Effects
There are several strategies you can use to manage these initial weird feelings:
- For Nausea: Try taking Lexapro with food [1.5.4]. Eating smaller, more frequent meals and avoiding spicy or fatty foods can also help [1.5.4].
- For Sleep Issues: If Lexapro makes you drowsy, your doctor might suggest taking it in the evening. If it causes insomnia, taking it in the morning is often recommended [1.5.1, 1.5.3]. Establishing a regular sleep routine can also be beneficial [1.5.4].
- For Headaches: Rest and drink plenty of fluids. An over-the-counter pain reliever like acetaminophen may help, but it's best to consult your doctor first [1.5.4].
- For Dry Mouth: Chewing sugar-free gum or drinking plenty of water can provide relief [1.5.1, 1.5.4].
It is crucial to take the medication consistently as prescribed and to avoid alcohol, which can worsen side effects [1.5.3, 1.5.6].
Comparison of Common SSRI Side Effects
Lexapro is just one of several SSRIs. While they work similarly, their side effect profiles can differ slightly.
| Medication | Common Side Effects | Distinguishing Features |
|---|---|---|
| Lexapro (Escitalopram) | Nausea, insomnia, sexual problems, fatigue [1.6.1, 1.2.3] | Highly selective for serotonin, which may lead to fewer side effects for some people compared to other SSRIs [1.6.4]. |
| Zoloft (Sertraline) | Nausea, diarrhea, tremors [1.6.1] | May be more likely to cause gastrointestinal issues like diarrhea compared to other SSRIs [1.6.4]. |
| Prozac (Fluoxetine) | Nausea, insomnia, nervousness, headache [1.6.1, 1.6.3] | Has a long half-life, which can mean fewer withdrawal symptoms if a dose is missed [1.6.4]. |
When to Contact a Doctor
While feeling weird is often a normal part of the adjustment, some side effects are more serious and warrant immediate medical attention. It's important to know the difference between temporary discomfort and a potential problem.
Contact your doctor right away if you experience:
- Worsening depression or suicidal thoughts: All antidepressants carry a boxed warning for an increased risk of suicidal thoughts and behaviors, particularly in people under 25, especially during the first few months of treatment or after a dose change [1.2.3, 1.7.1].
- Symptoms of Serotonin Syndrome: This is a rare but life-threatening condition caused by too much serotonin. Symptoms include agitation, confusion, hallucinations, rapid heartbeat, fever, sweating, muscle stiffness, or twitching [1.2.1, 1.7.2].
- Manic Episodes: Symptoms include extremely elevated mood, racing thoughts, reckless behavior, and a decreased need for sleep [1.2.3, 1.7.1].
- Severe Allergic Reaction: Signs can include rash, hives, difficulty breathing, or swelling of the face, tongue, or throat [1.7.2].
- Other Serious Symptoms: These can include seizures, abnormal bleeding, severe confusion, eye pain, or changes in vision [1.7.1, 1.7.2].
You should also consult your doctor if common side effects persist for more than a few weeks or interfere significantly with your daily life, as a dose adjustment may be needed [1.2.1, 1.2.4].
Conclusion
Feeling weird, anxious, or physically off when first starting Lexapro is a common and usually temporary experience. Your body is adapting to a new medication that alters brain chemistry to ultimately improve your mood and reduce anxiety. Patience is key, as it often takes four to six weeks for the initial side effects to fade and the full benefits to emerge [1.4.2]. However, it is vital to maintain open communication with your healthcare provider. Never hesitate to reach out to them with concerns, and seek immediate medical help for any severe or alarming symptoms. Do not stop taking Lexapro abruptly without medical guidance, as this can lead to unpleasant withdrawal symptoms [1.7.2].
For more information from an authoritative source, you can visit the National Alliance on Mental Illness (NAMI) page on Escitalopram.
