Lexapro is the brand name for escitalopram. It's one of the most widely prescribed SSRIs in the world, used as a first-line treatment for depression and generalised anxiety disorder. It's also commonly used for panic disorder, social anxiety, OCD, and PMDD. If a GP is going to put someone on an antidepressant for the first time, this is usually the one, because it tends to be the best-tolerated SSRI with the cleanest drug interaction profile.

It works by raising serotonin levels in the brain, which over weeks lifts mood, dampens anxiety, and quiets the loops of rumination, worry, and panic that drive these conditions. Most people on it describe the effect as turning the volume down on the bad stuff, life still happens but it stops hitting as hard.

It's a prescription drug, takes 4-6 weeks to reach full effect, and stopping abruptly causes a real withdrawal syndrome. This is not a compound to start or stop on a whim.

Deep-dive

Dosage:

• Standard adult dose: 10-20 mg/day, usually taken once daily in the morning or evening. Start at 10 mg for depression and GAD, 5 mg for panic disorder or anxiety-dominant presentations to avoid early activation. Titrate after 1-2 weeks if needed. Maximum is 20 mg/day for most indications, occasionally 30 mg off-label for OCD
• Older adults: Maximum 10 mg/day, start at 5 mg. Clearance is lower and hyponatraemia risk is higher
• PMDD: Either continuous 10-20 mg/day or luteal-phase dosing starting 14 days before expected menses and stopping with bleed onset. Luteal-phase dosing has comparable efficacy with less total drug exposure
• Time to effect: Anxiety and physical symptoms (sleep, appetite) often improve in 1-2 weeks. Mood and cognitive symptoms take 4-6 weeks. Don't judge full response before week 6. If there's no movement by week 8 at adequate dose, it's reasonable to consider switching or augmenting
• Timing: Morning vs evening depends on whether it makes you sleepy or activated. Both are common. Try one for a week, if sleep is disrupted, switch
• Discontinuation: Never stop abruptly. Escitalopram has a 27-30 hour half-life which puts it in the moderate-risk category for discontinuation syndrome, better than paroxetine and venlafaxine but worse than fluoxetine. Standard guidance is to taper by 5 mg every 2-4 weeks. Hyperbolic tapering (smaller proportional reductions as you get lower) is increasingly recommended, especially after long-term use. The last 2-3 mg often cause the most withdrawal symptoms, which is why liquid escitalopram or compounded smaller doses are sometimes needed for the final taper
• Missing a dose: One missed dose isn't a big deal. Two or three in a row can trigger discontinuation symptoms. If you regularly forget, set a phone alarm
• Alcohol: Not a hard contraindication but the combination tends to amplify sedation, blunt the antidepressant effect, and worsen sleep architecture. Moderate use is generally tolerated
• Hard contraindications: MAOIs (need 14-day washout in either direction), pimozide, linezolid, methylene blue. Combining with serotonergic drugs (other SSRIs/SNRIs, MDMA, tramadol, triptans, dextromethorphan, St John's wort, 5-HTP) raises serotonin syndrome risk
• Lab interactions to know: Tramadol (raises serotonin syndrome risk and lowers seizure threshold), NSAIDs and aspirin (increased bleeding risk), warfarin (variable INR effects), QT-prolonging drugs (additive QT effect)

Here's what you can expect:

The first 1-2 weeks are often the worst. Nausea, headache, jitteriness, vivid dreams, sleep disruption, transiently increased anxiety or panic, mild GI symptoms. Most of this fades by week 3-4. This is the most common period for people to quit before the drug has had a chance to work, so it helps to know it's coming. Starting at 5 mg for the first week, even when the target is 10, makes a meaningful difference for sensitive people.

Real therapeutic benefit comes in stages. Physical symptoms (sleep, appetite, somatic anxiety) often shift first, by week 2-3. Mood, energy, and cognitive symptoms (rumination, hopelessness, difficulty concentrating) shift slower, often by week 4-6. The classic pattern with depression is that people feel more capable of action before they feel happier, which is one reason the early weeks have a slight increased risk of self-harm in vulnerable people, the depression hasn't lifted but the inertia has.