Matt S

In recent years about 1 in 5 adults in the United States reported treatment for mental health. If you or someone close to you has started taking Lexapro (escitalopram oxalate) you may be wondering: “When is the best time to take escitalopram for anxiety?” To best answer this question, it is helpful to discuss how the medication works and its potential side effects. With this knowledge, you will be more able to use Lexapro comfortably and effectively. Let’s get started! Best Time To Take Lexapro For Anxiety If your doctor suggested a specific time to take Lexapro, it will be best to start using the medication at the suggested time. If you are having concerns with how you are feeling after starting Lexapro be sure to inform your doctor. Keeping these key ideas in mind is helpful: ● Lexapro does not need to be taken at a specific time of day to be effective, but it does need to be taken daily consistently over time. ● Difficulty sleeping (Insomnia) can be caused by Lexapro – switching Lexapro from night to morning can help prevent this side effect. ● Responses for individuals can vary – taking Lexapro at night can be appropriate for some patients if it has been causing drowsiness during the day. It does take time for your body to adjust to the medication. This adjustment allows the medication to become more effective and can also ease some of the initial side effects of Lexapro. Having a deeper understanding of how the medication works can help you be more prepared for what to expect and what to watch for. What Is Lexapro? Lexapro belongs to a class of medications called selective serotonin reuptake inhibitors, or SSRIs. These medications are also commonly called antidepressants, a term that can be confusing for individuals who may be using the medication more specifically to treat anxiety. Many antidepressants have also been shown to improve the management of anxiety symptoms and are widely used for this purpose. Lexapro is FDA-approved for the management of: ● Major Depressive Disorder (MDD) ● Generalized Anxiety Disorder (GAD) Lexapro is also commonly used to support patients managing several other conditions. These are considered “off-label” and include: ● Panic Disorder ● Post Traumatic Stress Disorder (PTSD) ● Obsessive Compulsive Disorder (OCD) ● Social Anxiety Disorder (SAD) ● Premenstrual Dysphoric Disorder (PMDD) ● Vasomotor Symptoms of Menopause (i.e. hot flashes) Multiple types of therapy are available and can be effective in their own right for these conditions. Regular sessions with a therapist are often combined with the use of medications like Lexapro for additional support. How Does Lexapro Work? Lexapro increases levels of the neurotransmitter serotonin. Mechanism of Action of Lexapro Our bodies use neurotransmitters such as serotonin to transmit signals or information along neural pathways. These signals help define our mood, our responses to stress, and how we feel. Lexapro causes serotonin to build up by slowing down the reuptake of the serotonin nerve cells release, which is why it is considered a selective serotonin reuptake inhibitor. This increase in serotonin levels helps with the management of anxiety and depression symptoms. Selective Serotonin Reuptake Inhibitors May Have A Delayed Effect When starting Lexapro it is essential to be aware that the medication can take several weeks to become effective. Research is showing that your individual genetics can play a role in how well the medication may work for you, and how likely side effects may be. It is best to give the medication up to four to six weeks to work so your body will have a chance to fully regulate serotonin receptors. Lexapro Common Dosage Lexapro dosage when treating anxiety will be defined by your doctor. A common approach is to “start low and go slow,” meaning lower doses of the medication are often used early in therapy and may be increased if needed for additional support. Lexapro is available in 5mg, 10mg, and 20mg tablets. ● 10mg is a common starting dose for anxiety. ● 20mg is the maximum recommended dose. Package insert instructions suggest a minimum of one week before a dose increase, but many clinicians opt to schedule an appointment four to six weeks after starting therapy. This allows Lexapro to start working after the first few weeks on a regular dosing schedule and gives you a chance to get a better feel for how well the medication has been working for you. Many patients taking Lexapro start with a prescribed dose of 10mg daily. Lexapro Side Effects Some individuals prefer to use supplements for managing anxiety symptoms. It is important to ensure these are reputable brands as they do not require rigorous review by the FDA to enter the market. Researching brands like HUM is helpful prior to use. Lexapro is considered a generally well-tolerated medication. There are potential side effects to be aware of, however. These effects do not occur for everyone but do happen for a significant number of individuals. ● Suicidal Thoughts: Use of Lexapro has been associated with suicidal thoughts. It is important to note that the conditions Lexapro is being used to treat are also associated with suicidal ideation, particularly when left untreated. Regardless of whether or not you are using a medication, it is important that you know that you and the people you care about are not alone. Confidential, professional support is available for free 24 hours a day, 7 days a week in the United States by dialing 988 or visiting 988lifeline.org. ● Gastrointestinal effects, like nausea or diarrhea: These effects are most common early in therapy and may go away on their own after an adjustment period. If these effects are unbearable or last longer than a week, it’s time to talk with your doctor. ● Insomnia, or difficulty sleeping: If you are having trouble sleeping, it is okay to consider taking Lexapro in the morning. This may help reduce the impact the medication has on your sleep. ● Drowsiness: Drowsiness and sometimes dizziness can occur but often get better as your body adjusts to Lexapro. If you feel as though you may fall or if these effects persist for longer than a week, it is time to contact your doctor. ● Sexual Dysfunction: Lexapro has been associated with decreased libido or sexual desire in some individuals. It has also been linked to delayed orgasms or the inability to achieve orgasm. These effects have a tendency to be more easily missed when discussing your treatment with your doctor. If you have a concern, it’s important to make sure you voice it! What to do if You Miss A Dose Taking the medication every day is important to make sure it remains effective, but it also prevents potential Lexapro withdrawal symptoms. Missed doses or stopping suddenly is associated with dizziness, difficulty concentrating, difficulty sleeping, and other symptoms. If you miss a day do not double dose – simply resume your normal daily dose. Drug Interactions Serotonin Syndrome When Lexapro is combined with other medications that increase serotonin it is possible for these levels to become too concentrated, potentially leading to serotonin syndrome. The symptoms most often associated with serotonin syndrome are palpitations (feeling your heart pounding or racing), sweating, and confusion, among others. These symptoms may be more likely to occur if you are taking multiple behavioral health medications, including certain sleep aids. Smoking Smoking can lower concentrations of Lexapro in your body, which can make the medication less effective. Nicotine products — including vaping — are also associated with increased anxiety in some individuals. Alcohol The overall impact of drinking while taking antidepressants is not well-defined, but caution should still be exercised. Evidence shows that alcohol combined with antidepressants causes individuals to become more heavily intoxicated. This can cause more concerns with coordination and executive function, like decision-making. Discussing how alcohol interacts with Lexapro is helpful if you do plan to drink. Over-The-Counter Pain Medications Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil), naproxen (Aleve), and aspirin raise the risk of bleeding, particularly when combined with SSRIs like Lexapro. This combination can also increase the risk of stomach ulcers. Should You Take Lexapro In The Morning? Many patients benefit from taking Lexapro in the morning to limit the potential for insomnia. Lexapro can cause difficulty sleeping. Conclusion Taking Lexapro consistently each day over time is important to help the medication work and limit side effects associated with missed doses. The time of day does not impact how well the medication works. Timing does have the potential to impact side effects, and taking Lexapro in the morning limits the potential impact on sleep. This makes morning dosing an effective strategy for many people! F.A.Q Q: I’m worried about side effects. Is Lexapro safe? A: Yes. Choosing not to treat anxiety and other conditions carries its own set of risks. It is important to be aware of potential side effects so if they do occur you are more able to determine whether the way you are feeling may be caused by the medication. This allows for more productive conversations with your doctor. Resources Terlizzi, Emily P. and Norris, Tina (2021). Mental health treatment among adults : United States, 2020. (419). https://stacks.cdc.gov/view/cdc/110593 Forest Laboratories. “Lexapro Package Insert.” January 2017. Accessed October 12, 2023. Borwin, Bandelow; et al. "Efficacy of treatments for anxiety disorders, a meta-analysis." International Clinical Psychopharmacology, July 2015. Accessed October 12, 2023. Baldwin, David S.; et al. "Efficacy of escitalopram in the treatment of social anxiety disorder: A meta-analysis versus placebo." European Neuropsychopharmacology, June 2016. Accessed October 12, 2023. Marjoribanks, Jane; et al. "Selective serotonin reuptake inhibitors for premenstrual syndrome." Cochrane Database of Systematic Reviews, June 2013. Accessed October 12, 2023. Carpenter, Joseph K.; et al. 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