Escitalopram - Chris Aiken, MD

Q: Depression

Escitalopram use based on FDA approval in major depressive disorder. SSRI side effects reviewed with patient.

Q: Anxiety Disorder

Escitalopram use based on FDA approval in Generalized Anxiety Disorder and efficacy of this class in other anxiety disorders (Panic Disorder, PTSD, and Social Anxiety Disorder). SSRI side effects reviewed with patient.

Q: OCD

Escitalopram use based on efficacy of this class in OCD. SSRI side effects reviewed with patient.

Q: Binge Eating & Bulimia

Escitalopram use based on efficacy of this class in binge eating and bulimia. SSRI side effects reviewed with patient.

Q: Premenstrual Syndrome

Escitalopram use based on efficacy of this class in Premenstrual Syndrome. SSRI side effects reviewed with patient.

Q: Menopausal Symptoms

Escitalopram use based on controlled trials in menopausal symptoms (vasomotor and mood). SSRI side effects reviewed with patient.

Excitalopram (Lexapro)

SSRI antidepressant

Major Depression (age 12+)²
OCD³

Generalized Anxiety (age 7+)²
Menopausal symptoms²

Features

Medication, Generic, Elderly-Safe, Child-Approved, Tolerable, Non-controlled, Elderly-Preferred, Child-Studied

Handout

Dosing

Depression (10-20 mg/d), Anxiety disorders (20-30 mg/d), Menopausal symptoms (10-20 mg qhs). Dose unknown in OCD so avoid there.

CHILD MDD: ≥12 years: 10 mg po qd; may increase dose after at least 3 weeks; not to exceed 20 mg/day.

CHILD GAD: ≥7 years: 10 mg po qd; may increase dose after 2 weeks; not to exceed 20 mg/day.

40 mg citalopram = 20 mg escitalopram (since citalopram is a 50/50 racemic mixture, 50% escitalopram).

INTERACTIONS: Does not alter other med levels but its own levels are raised by 2C19 inhibitors like common proton pump inhibitors (ranitidine/Zantac). Raise dose by x1.3 if using with carbamazepine.

Management

Preferred over citalopram. Good to pair with bupropion as does not interact with that. Good in elderly due to lack of drug interactions. Possibly more effective and better tolerated than other SSRIs.

TOLERABILITY: Apathy, sexual dysfunction, sleep disruption, nausea, restless legs, akathisia, sweating, yawning, withdrawal syndrome.

RISKS: Suicidality in age < 25, mania, osteopenia in post-menopausal women, increased bleeding, hyponatremia (mainly in elderly).