Common Side Effects of Lexapro: Beyond the Most Frequent
While nausea may be the most common early side effect, the full picture of Lexapro's impact is more nuanced, involving a range of autonomic, gastrointestinal, and sexual issues. These reactions can differ in severity and duration, with many initial symptoms, including nausea, often improving as the body adjusts to the medication. However, sexual side effects may persist longer and sometimes require alternative management strategies.
The Most Prevalent Early Reactions
- Nausea: As the #1 side effect of Lexapro, nausea occurs in a significant number of patients, especially during the first one to two weeks of therapy. This is believed to be related to serotonin's influence on the gastrointestinal system, as a high percentage of the body's serotonin is located there.
- Insomnia and Somnolence: Lexapro can cause both sleeplessness and excessive drowsiness. Some individuals experience difficulty falling or staying asleep (insomnia), while others feel fatigued or sleepy during the day (somnolence). Adjusting the timing of the dose (morning versus evening) can sometimes alleviate these issues.
- Increased Sweating (Hyperhidrosis): This autonomic nervous system effect is a relatively common side effect, affecting about 5% of patients taking Lexapro for depression in clinical trials. The exact mechanism is not fully understood but may involve the regulation of body temperature.
- Fatigue: A feeling of persistent tiredness or lack of energy is a known side effect, especially early in treatment. Like other initial side effects, fatigue often diminishes over the first few weeks as the body adapts.
Persistent and Sexual Side Effects
One class of side effects that often does not improve with time is related to sexual function. These can be a major source of distress and treatment non-adherence for patients.
- Ejaculation Disorder: The most common sexual side effect in men is delayed ejaculation or inability to ejaculate. Clinical trial data shows this occurs in 9-14% of male patients on Lexapro for depression or anxiety.
- Decreased Libido: A reduced sex drive can affect both male and female patients and is a persistent issue for many. Studies indicate that serotonin's impact on other neurotransmitters like dopamine and testosterone may inhibit sexual desire.
- Anorgasmia: Difficulty achieving orgasm or inability to have an orgasm is another common sexual side effect, particularly in women.
Comparing Common Lexapro Side Effects
This comparison table illustrates the approximate incidence of some common side effects in adults taking 10-20 mg/day of Lexapro, based on clinical trial data.
| Adverse Reaction | Lexapro (Depression) | Placebo (Depression) | Lexapro (Anxiety) | Placebo (Anxiety) |
|---|---|---|---|---|
| Nausea | 15% | 7% | 18% | 8% |
| Insomnia | 9% | 4% | 12% | 6% |
| Ejaculation Disorder | 9%* | <1%* | 14%* | 2%* |
| Fatigue | 5% | 2% | 8% | 2% |
| Sweating Increased | 5% | 2% | 4% | 1% |
| Decreased Libido | 3% | 1% | 7% | 2% |
| Somnolence (Drowsiness) | 6% | 4% | 13% | 7% |
- Denominator is male patients only.
Other Notable Side Effects and When to Seek Help
Beyond the most common, other side effects can occur. These can range from mild annoyances to serious health concerns. Users should be vigilant and report any unusual symptoms to their healthcare provider.
- Gastrointestinal Issues: Diarrhea, constipation, dry mouth, and abdominal pain are frequently reported.
- Neurological Concerns: Dizziness and headache are common. More rarely, serotonin syndrome can occur, marked by agitation, confusion, rapid heart rate, and muscle stiffness.
- Black Box Warning: Lexapro, like other SSRIs, carries a black box warning from the FDA regarding an increased risk of suicidal thoughts and behavior, particularly in young adults, adolescents, and children.
Conclusion
Nausea, especially in the initial weeks, is the most statistically common side effect of Lexapro. However, a broader range of side effects exists, including sexual dysfunction, sleep disturbances, fatigue, and increased sweating. For many, initial side effects improve as their body adapts to the medication. Persistent side effects, particularly sexual ones, may require discussion with a doctor to adjust dosage or consider alternative treatment strategies. It is crucial for patients to maintain open communication with their healthcare providers to manage side effects and ensure the treatment's overall effectiveness and safety. For more in-depth information and patient support, consult authoritative sources like the National Alliance on Mental Illness (NAMI).
