Lexapro, the brand name for escitalopram, is a widely prescribed selective serotonin reuptake inhibitor (SSRI) [1.11.4]. It is approved by the FDA for treating major depressive disorder (MDD) in adults and adolescents (12 and older) and generalized anxiety disorder (GAD) in adults [1.11.1, 1.3.5]. It works by increasing levels of serotonin, a neurotransmitter in the brain that helps regulate mood [1.10.3]. While effective, starting this medication can come with an adjustment period and initial side effects. The most common question for new users is about the duration and intensity of these effects.
The Adjustment Period: What to Expect in the First Few Weeks
When starting Lexapro, the body needs time to adapt to the changes in serotonin levels. During this initial phase, often lasting one to two weeks, side effects can be most noticeable [1.2.2, 1.2.3]. Many of these early side effects are mild to moderate and tend to resolve on their own [1.2.4].
Common Initial Side Effects
During the first week or two, you may experience a range of symptoms as your body adjusts. These often include:
- Gastrointestinal Issues: Nausea is one of the most common side effects, affecting around 15% of users in some studies [1.5.2]. Diarrhea, dry mouth, and changes in appetite are also frequently reported [1.3.1, 1.3.5].
- Sleep Disturbances: Some individuals may experience insomnia (trouble sleeping), while others might feel drowsy or fatigued [1.3.1, 1.4.2]. Vivid or unusual dreams can also occur [1.2.5].
- Neurological and Mood Changes: Headaches, increased sweating, and dizziness are common [1.3.5]. Paradoxically, some people report a temporary increase in anxiety or restlessness when first starting the medication [1.2.2, 1.8.4].
Most of these initial effects diminish significantly after the first two weeks [1.2.3]. The therapeutic benefits of Lexapro, such as improved mood and reduced anxiety, typically take longer to become apparent, often between 4 to 8 weeks [1.2.1].
Timeline for Improvement
While individual experiences vary, a general timeline for the resolution of side effects and the onset of therapeutic effects can be observed.
- Weeks 1-2: This is the primary adjustment period. Side effects like nausea, headaches, and sleep changes are most prominent. These usually begin to fade toward the end of this period [1.2.2]. You may notice early improvements in sleep and appetite before mood changes occur [1.2.1].
- Weeks 2-4: Many people start to notice a definite reduction in side effects. At the same time, the initial therapeutic benefits, such as a subtle reduction in anxiety, may begin to emerge [1.2.1].
- Weeks 4-8: By this point, most initial side effects should have significantly subsided or resolved completely [1.2.1]. The full antidepressant and anti-anxiety effects of the medication are typically felt within this timeframe [1.2.5]. If side effects persist or are bothersome, it is important to consult a healthcare provider [1.2.2].
Strategies for Managing Initial Side Effects
There are several practical strategies that can help minimize the discomfort of initial side effects:
- Nausea: Take Lexapro with a small amount of food, like crackers, to reduce stomach upset. Avoiding rich or spicy foods can also help [1.4.1, 1.4.2].
- Insomnia: If you have trouble sleeping, try taking your dose in the morning [1.4.2]. Maintaining a consistent sleep schedule can also be beneficial [1.4.3].
- Drowsiness: If the medication makes you feel tired, taking it in the evening before bed may be a better option [1.4.2].
- Headaches: Ensure you are well-hydrated and get adequate rest. An over-the-counter pain reliever may be used after consulting with a pharmacist or doctor [1.4.2].
- Dry Mouth: Chewing sugar-free gum or sucking on sugar-free sweets can help stimulate saliva production [1.4.2].
Comparison of Common Side Effects: Lexapro vs. Zoloft
Lexapro and Zoloft (sertraline) are both popular SSRIs. While they share many similarities, there are some differences in their side effect profiles.
| Side Effect | Lexapro (escitalopram) | Zoloft (sertraline) | Notes |
|---|---|---|---|
| Nausea | Affects ~15% of users [1.5.2] | More common, affects ~26% of users [1.5.2] | Often subsides after the initial weeks. |
| Diarrhea | Affects ~8% of users [1.5.1] | More common, affects ~20% of users [1.5.1] | Tends to be more frequent with Zoloft. |
| Sleep Issues | Can cause both insomnia and sleepiness [1.5.5] | More likely to cause insomnia than Lexapro [1.5.3] | Timing of the dose can help manage this. |
| Sexual Side Effects | Ejaculation issues reported in ~12% of men [1.5.2] | Ejaculation issues reported in ~8% of men [1.5.2] | These side effects may not diminish over time [1.6.5]. |
| Dry Mouth | Common [1.5.3] | Common [1.5.3] | A shared side effect for many SSRIs. |
It is important to note that while Zoloft may cause side effects more frequently, some studies suggest that Lexapro's side effects, when they do occur, may be perceived as less tolerable by a small percentage of users [1.5.1].
When to Contact a Healthcare Provider
While most side effects are mild and temporary, there are certain situations where you should contact your doctor promptly:
- If side effects are severe or do not improve after a few weeks [1.2.2].
- If you experience any new or worsening depression or have thoughts of self-harm, which is a rare but serious risk, especially in children and young adults (this carries an FDA black box warning) [1.3.5, 1.5.4].
- If you experience symptoms of serotonin syndrome, a rare but potentially life-threatening condition. Symptoms include high fever, agitation, confusion, muscle stiffness, and a rapid heartbeat [1.8.1].
- If you have signs of an allergic reaction, such as a rash, itching, or swelling of the face, tongue, or throat [1.3.1].
- If you plan to stop taking the medication. Abruptly stopping Lexapro can lead to discontinuation symptoms (withdrawal), such as dizziness, nausea, irritability, and 'brain zaps' [1.9.2, 1.9.4]. A doctor can help you create a tapering plan to minimize these effects [1.9.4].
Conclusion
For the majority of individuals, the initial side effects of Lexapro do get better. The first one to two weeks are typically the most challenging, but with patience and simple management strategies, these effects usually fade as the body adjusts. The therapeutic benefits often take 4 to 8 weeks to fully materialize. Open communication with a healthcare provider is essential throughout this process to ensure the treatment is both safe and effective, and to address any persistent or severe side effects.
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a qualified healthcare professional before starting or stopping any medication.
