What is Lexapro (Escitalopram)?
Lexapro, with the generic name escitalopram, is a widely prescribed antidepressant belonging to the selective serotonin reuptake inhibitor (SSRI) class of drugs [1.2.2]. It works by increasing the levels of serotonin, a neurotransmitter in the brain, which helps to improve mood and reduce anxiety [1.5.3]. The FDA has approved Lexapro for the treatment of Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD) [1.3.1]. Due to its mechanism of action, it can sometimes be associated with gastrointestinal side effects, especially during the initial phase of treatment [1.5.6].
The Official Recommendation: With or Without Food?
According to official FDA guidelines and patient information, Lexapro can be administered once daily, either in the morning or evening, with or without food [1.3.1, 1.3.2]. Studies on its pharmacokinetics show that food does not affect the overall absorption of the drug into the bloodstream [1.8.2, 1.8.4]. This means the medication's effectiveness in treating depression or anxiety is not compromised if taken on an empty stomach. However, while medically permissible, taking it without a meal is not always the most comfortable option for the patient. Healthcare professionals often recommend taking it with food to minimize potential side effects [1.3.5].
What Happens If You Take Lexapro Without Eating?
The most common consequence of taking Lexapro on an empty stomach is an increased likelihood of experiencing nausea and stomach upset [1.2.1, 1.2.3]. While not dangerous, this side effect can be very uncomfortable and may affect a person's willingness to continue the medication. Other possible gastrointestinal issues include diarrhea, stomach pain, and general indigestion [1.2.4]. The severity of these symptoms varies greatly from person to person; some may not notice any difference, while others may find the nausea significant [1.2.1].
Why Does Lexapro Cause Nausea?
The reason Lexapro can irritate the stomach is linked directly to its primary function: increasing serotonin. While most think of serotonin as a brain chemical, a large number of serotonin receptors are also located in the gastrointestinal tract, where they play a role in digestion and gut motility [1.5.3, 1.4.6]. When Lexapro is introduced, the sudden increase in serotonin can overstimulate these gut receptors, leading to feelings of nausea [1.4.6]. When you eat, food acts as a physical buffer in the stomach, which can lessen this irritation and reduce the intensity of the nausea [1.4.3].
Comparison: Taking Lexapro With vs. Without Food
| Feature | With Food | Without Food (Empty Stomach) |
|---|---|---|
| Likelihood of Nausea | Lower; food acts as a buffer for the stomach lining [1.4.3]. | Higher; direct irritation of gut serotonin receptors is more likely [1.2.1]. |
| Medication Absorption | Unaffected; the drug's bioavailability remains consistent [1.8.2]. | Unaffected; the drug is well-absorbed regardless of meals [1.8.5]. |
| Stomach Comfort | Generally better, especially for new users or those sensitive to side effects [1.3.5]. | Increased risk of upset stomach, indigestion, or discomfort [1.2.3]. |
| Recommended For | Individuals starting the medication or those who have previously experienced GI side effects [1.4.2]. | Individuals who do not experience nausea or other stomach-related side effects. |
Strategies to Minimize Nausea and Stomach Upset
If you experience nausea, several strategies can help manage this common side effect:
- Take with Food: The simplest method is to take your dose with a meal or a small, bland snack like crackers or toast [1.2.3].
- Choose Bland Foods: Avoid rich, spicy, or fatty foods around the time you take your medication, as they can worsen stomach issues [1.4.3]. The BRAT diet (bananas, rice, applesauce, toast) can be particularly gentle [1.7.3].
- Adjust Your Timing: If you take Lexapro in the morning and experience nausea, try switching to taking it at night after dinner. This allows you to sleep through the worst of the potential discomfort [1.4.4].
- Stay Hydrated: Drinking plenty of cool water throughout the day can help settle your stomach [1.7.5].
- Talk to Your Doctor: If nausea is severe or persistent, do not stop taking your medication. Instead, contact your healthcare provider. They may suggest a dose adjustment or other interventions [1.4.2].
Conclusion
While taking Lexapro without food is officially sanctioned and does not reduce the medication's effectiveness, it significantly increases the risk of nausea and stomach upset [1.8.5, 1.2.1]. This is because of the drug's effect on serotonin receptors in the digestive system [1.4.6]. For most people, especially when first starting the medication, taking Lexapro with a meal or a light snack is the best practice to ensure comfort and adherence to the treatment plan. If side effects persist, it is crucial to consult a healthcare professional for personalized advice.
For more information from an authoritative source, you can review the FDA's medication guide for Escitalopram [1.3.2].
