Why do doctors choose Lexapro? Understanding this first-line antidepressant

October 6, 2025 •

3 min read

In 2023, escitalopram, the generic version of Lexapro, was the 14th most commonly prescribed medication in the United States, with over 37 million prescriptions. This widespread use highlights a significant confidence among healthcare professionals, leading many to ask: why do doctors choose Lexapro for depression and anxiety?

Quick Summary

Lexapro (escitalopram) is a highly effective and well-tolerated SSRI often chosen by doctors as a first-line treatment for major depressive disorder and generalized anxiety disorder. Its high selectivity for serotonin and favorable side effect profile compared to other antidepressants are key factors in its preference among prescribers.

Key Points

High Selectivity: Lexapro's unique allosteric mechanism results in a more potent and selective action on serotonin transporters, potentially enhancing its effectiveness and onset.
Favorable Tolerability: The medication is often chosen for its manageable side effect profile and lower discontinuation rates compared to many other antidepressants.
First-Line Treatment: Its robust efficacy in treating MDD and GAD makes Lexapro a standard, first-line option for many doctors and patients.
Pediatric Approval: Lexapro is one of the few SSRIs approved for GAD in children as young as 7 and MDD in adolescents 12 and older.
Lower Drug Interaction Risk: Due to its limited impact on key liver enzymes, Lexapro poses a lower risk of interacting with other medications.
Long-Term Efficacy: Clinical data supports Lexapro's use for long-term maintenance therapy and preventing relapse in depression and anxiety disorders.

What is Lexapro and How Does it Work?

Lexapro is the brand name for escitalopram, an SSRI that increases serotonin levels in the brain by blocking its reabsorption. This neurotransmitter is vital for regulating mood. Escitalopram is the active component of citalopram, making it more potent and selective for the serotonin transporter (SERT). It also has an allosteric effect, binding to a secondary site on the SERT, which further enhances serotonin reuptake inhibition and may lead to a faster onset of action.

The Primary Advantages for Prescribers

Doctors consider several advantages when prescribing Lexapro:

High Efficacy: Lexapro is effective in reducing symptoms of major depressive disorder (MDD) and generalized anxiety disorder (GAD) and is a first-line treatment.
Excellent Tolerability: It is generally well-tolerated with mild side effects, leading to better patient adherence.
High Selectivity and Low Drug Interaction Potential: Its high selectivity for the serotonin transporter and minimal interaction with liver enzymes reduce the risk of drug-drug interactions, making it safer for patients taking multiple medications.
Predictable Profile: The well-documented side effect profile allows doctors to manage patient expectations.
Proven Relapse Prevention: Studies show Lexapro is effective in preventing the recurrence of depression and anxiety symptoms.

Patient Profile for Lexapro Prescription

Lexapro is FDA-approved for adults and pediatric patients (12+) with MDD and adults and pediatric patients (7+) with GAD. It may also be prescribed off-label for other conditions like panic disorder or social anxiety disorder. It's suitable for patients experiencing classic symptoms of depression or excessive, uncontrollable worry associated with GAD.

Lexapro vs. Other Common Antidepressants

Choosing an antidepressant involves considering efficacy, side effects, and approvals. Here's a comparison:


Feature	Lexapro (escitalopram)	Zoloft (sertraline)	Celexa (citalopram)	Wellbutrin (bupropion)	Paxil (paroxetine)
Drug Class	SSRI (allosteric)	SSRI	SSRI	NDRI	SSRI
Mechanism	Highly selective 5-HT reuptake inhibitor with allosteric action.	Primary 5-HT reuptake inhibitor with moderate DAT inhibition.	Primary 5-HT reuptake inhibitor.	NE and DA reuptake inhibitor, no effect on 5-HT.	Primary 5-HT reuptake inhibitor; potent anticholinergic effects.
Key FDA Approvals	MDD (12+), GAD (7+).	MDD (adult), OCD, PTSD, SAD, Panic Disorder, PMDD.	MDD (adult), some off-label uses.	MDD, Seasonal Affective Disorder.	MDD, OCD, Panic Disorder, SAD, PTSD.
Tolerability	Excellent, often considered best-tolerated SSRI.	Generally good, but higher GI side effects.	Good, but associated with QT prolongation at higher doses.	Less sexual dysfunction risk, but higher seizure risk at high doses.	High rate of side effects (sedation, weight gain) and withdrawal symptoms.
Selectivity	Highest selectivity for SERT among SSRIs.	High selectivity for SERT, but less than escitalopram.	High selectivity, but racemic form is less pure than escitalopram.	Different mechanism of action.	High selectivity, but also significant non-serotonergic actions.

Potential Side Effects and Management

Common side effects of Lexapro include nausea, insomnia, fatigue, increased sweating, and sexual dysfunction, often temporary as the body adjusts. Serious but rare side effects include serotonin syndrome and an increased risk of suicidal thoughts in young adults (under 25) during early treatment, as noted by an FDA boxed warning. Gradual discontinuation under medical supervision is recommended.

Conclusion: The Clinical Rationale Behind the Choice

Doctors choose Lexapro for its strong clinical profile, combining high efficacy, good tolerability, and low drug interaction risk for depression and anxiety. While not suitable for everyone, its potent, selective action makes it a valuable first-line option, with the ultimate decision tailored to each patient's needs and history.

Helpful Resource: For detailed FDA prescribing information on Lexapro, visit the official document at: https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/021323s030s031,021365s021s022lbl.pdf.

List of Factors Influencing the Choice for Lexapro

Proven Efficacy: Effective for MDD and GAD.
Patient Tolerability: Mild and manageable side effect profile.
Fewer Drug Interactions: High selectivity reduces interaction risk.
Targeted Action: Unique allosteric mechanism.
Versatile Indications: Approved for MDD and GAD in various age groups and used off-label for other conditions.
Relapse Prevention: Effective in preventing symptom recurrence.
Generic Availability: Affordable generic version (escitalopram) is available.

Frequently Asked Questions

Studies suggest Lexapro may be modestly more effective than some other SSRIs and offers a good balance of efficacy and tolerability.

Initial improvements may be seen in 1-2 weeks, but full effects typically take 6 to 12 weeks.

Lexapro is the active S-enantiomer of Celexa, making it more potent, selective, and generally better tolerated, with a lower risk of heart-related side effects at high doses.

Lexapro has minimal impact on the liver enzymes that process most drugs, reducing the potential for interactions.

Common side effects include nausea, insomnia, fatigue, increased sweating, and sexual dysfunction, which often improve over time.

Yes, escitalopram is the more affordable generic version of Lexapro.

Yes, Lexapro is approved for MDD in patients aged 12 and older and GAD in patients aged 7 and older.