Escitalopram Side Effects

Medically reviewed by Drugs.com. Last updated on Jan 27, 2025.

Applies to escitalopram: oral solution, oral tablet.

Important warnings This medicine can cause some serious health issues

Oral route (tablet; solution)

Suicidal Thoughts and Behaviors. Antidepressants increased the risk of suicidal thoughts and behaviors in pediatric and young adult patients in short-term studies.

Closely monitor all antidepressant-treated patients for clinical worsening, and for emergence of suicidal thoughts and behaviors.

Escitalopram oxalate is not approved for use in pediatric patients less than 7 years of age.

Common side effects of escitalopram

Some side effects of escitalopram may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects.

Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common side effects

• diarrhea
• dry mouth
• heartburn
• sleepiness or unusual drowsiness
• trouble sleeping

Less common side effects

• bloated or full feeling
• burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
• decreased appetite
• excess air or gas in the stomach or bowels
• general feeling of discomfort or illness
• increased sweating
• joint pain
• muscle aches and pains
• pain in the neck or shoulders
• pain or tenderness around the eyes and cheekbones
• passing gas
• runny nose
• shivering
• sneezing
• stuffy nose
• tooth problems
• unusual dreams
• unusual drowsiness, dullness, tiredness, weakness or feeling of sluggishness
• yawning

Incidence not known

• blistering, peeling, loosening of the skin
• change in walking and balance
• clumsiness or unsteadiness
• decrease in smell
• hair loss or thinning of the hair
• increased sensitivity of skin to sunlight
• lack or loss of strength
• loss of sense of smell
• red irritated eyes
• red skin lesions, often with a purple center
• redness or other discoloration of the skin
• severe sunburn

Serious side effects of escitalopram

Along with its needed effects, escitalopram may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking escitalopram:

Less common side effects

• decreased interest in sexual intercourse
• delayed or inability to have an orgasm
• inability to have or keep an erection
• loss in sexual ability, desire, drive, or performance
• not able to have an orgasm

Rare side effects

• coma
• confusion
• decreased urine output
• dizziness
• fast or irregular heartbeat
• headache
• increased thirst
• muscle pain or cramps
• nausea or vomiting
• seizures
• swelling of the face, ankles, or hands
• trouble breathing
• unusual tiredness or weakness

Incidence not known

• bigger, dilated, or enlarged pupils (black part of the eye)
• black, tarry stools
• bloating
• blood in the urine
• bloody nose
• burning while urinating
• changes in skin color
• chest pain, discomfort, or tightness
• chills
• constipation
• cough
• dark-colored urine
• eye pain and blurred vision
• fainting
• fever
• heavier menstrual periods
• hives, itching, skin rash
• increased sensitivity of the eyes to light
• indigestion
• irregular or slow heart rate
• pain, redness, or swelling in the arm or leg
• pain or discomfort in the arms, jaw, back or neck
• pains in the stomach, side, or abdomen, possibly radiating to the back
• painful or difficult urination
• palpitations
• puffiness or swelling of the eyelids or around the eyes, face, lips
• sore throat
• sores, ulcers, or white spots on the lips or in the mouth
• stomach pain, continuing
• sweating
• swelling of the breasts or unusual milk production
• swelling of the foot or leg
• swollen or painful glands
• unusual bleeding or bruising
• vomiting of blood or material that looks like coffee grounds
• yellow eyes or skin

For healthcare professionals

Applies to escitalopram: oral solution, oral tablet.

General adverse events

Side effects have been reported to be generally mild and transient. They are most common during the first 2 weeks of treatment and decrease in intensity and frequency with continued treatment. They generally do not lead to treatment cessation.

The overall incidence of rates of side effects in trials with patients treated with escitalopram 10 mg per day (66%) was similar to placebo-treated patients (61%); the incidence rate in the group treated with escitalopram 20 mg per day was greater (86%). Common side effects that occurred in the 20 mg per day group with an incidence approximately twice that of the 10 mg group and approximately twice that of the placebo group included insomnia, diarrhea, dry mouth, somnolence, dizziness, increased sweating, constipation, fatigue, and indigestion.^[Ref]

Psychiatric

• Very common (10% or more): Insomnia (up to 14%)
• Common (1% to 10%): Abnormal dreams, agitation, anxiety, nervousness, restlessness
• Uncommon (0.1% to 1%): Abnormal thinking, aggravated depression, aggression/aggressive reaction, aggravated restlessness, alcohol problem, apathy, bruxism, confusion, confusional state, depersonalization, depression, emotional lability, excitability, feeling unreal, forgetfulness, visual/auditory hallucination, hypomania, irritability, jitteriness, obsessive-compulsive disorder, panic attack/reaction, paranoia/paroniria, sleep disorder, suicide attempt, tics
• Frequency not reported: Mania, suicidal ideation/behavior
• Postmarketing reports: Acute psychosis, anger, completed suicide, delirium, delusion, disorientation, non-accidental overdose, mood swings, nightmare, psychotic disorder, withdrawal syndrome^[Ref]

Antidepressants may have a role in inducing worsening of depression and the emergence of suicidality in certain patients during the early phases of treatment. An increased risk of suicidal thinking and behavior in children, adolescents, and young adults (aged 18 to 24 years) with major depressive disorder (MDD) and other psychiatric disorders has been reported with short-term use of antidepressant drugs.

Adult and pediatric patients receiving antidepressants for MDD, as well as for psychiatric and nonpsychiatric indications, have reported symptoms that may be precursors to emerging suicidality, including anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia, hypomania, and mania. Causality has not been established.^[Ref]

Nervous system

• Very common (10% or more): Headache (up to 24%), somnolence (up to 13%)
• Common (1% to 10%): Dizziness, lethargy, paresthesia, tremor
• Uncommon (0.1% to 1%): Amnesia, ataxia, carpal tunnel syndrome, cerebrovascular disorder, concentration impairment, dysesthesia, disequilibrium, dysgeusia, dystonia, hyperkinesia, hyperreflexia, hypertonia, hypoesthesia, lightheadedness, migraine, nerve root lesion, neuralgia, neuropathy, paralysis, sedation, syncope, taste alteration/perversion
• Rare (less than 0.1%): Serotonin syndrome
• Frequency not reported: Abnormal gait, cerebrovascular accident, choreoathetosis, convulsions/seizure, dyskinesia, extrapyramidal disorder, grand mal convulsions/seizures, myoclonus, movement disorder, psychomotor restlessness/akathisia
• Postmarketing reports: Dysarthria, neuroleptic malignant syndrome, nystagmus, parkinsonism, restless legs, tardive dyskinesia^[Ref]

Convulsions (including grand mal convulsions) have been reported with racemic citalopram.

Potentially life-threatening serotonin syndrome has been reported with SSRIs and SNRIs as monotherapy, but particularly with concomitant use of other serotonergic drugs and drugs that impair the metabolism of serotonin. Serotonin syndrome has been reported with racemic citalopram.

At least one case of escitalopram-induced paroxysmal dystonia has been reported in the literature. A 44-year-old woman developed paroxysmal cervical-cranial dystonia after receiving several days of treatment with escitalopram. The paroxysmal movement disorders were characterized by cervical and oral contracture with sustained and painful laterocollis and twisting tongue movements. The episodes occurred several times a day lasting for several minutes and would resolve spontaneously. The day after escitalopram was discontinued, the paroxysmal symptoms resolved without recurrence.^[Ref]

Cardiovascular

• Common (1% to 10%): Palpitation
• Uncommon (0.1% to 1%): Abnormal ECG, aggravated hypertension, angina pectoris, bradycardia, chest tightness, chest pain, flushing, hematoma, hot flush, hypertension, hypotension, myocardial infarction, myocardial ischemia, myocarditis, edema, edema of extremities, peripheral edema, peripheral ischemia, tachycardia, traumatic hematoma, varicose vein, vein disorder, vein distended
• Frequency not reported: Orthostatic hypotension, prolonged QT, torsades de pointes
• Postmarketing reports: Abnormal bleeding, atrial fibrillation, cardiac failure, deep vein thrombosis, hypertensive crisis, phlebitis, postural hypotension, thrombosis, ventricular arrhythmia, ventricular tachycardia^[Ref]

Cases of QT interval prolongation and ventricular arrhythmias reported in postmarketing experience were predominantly in females, with hypokalemia, or with pre-existing QT interval prolongation or other cardiac diseases.

Postural hypotension has been reported with other SSRIs.^[Ref]

Gastrointestinal

• Very common (10% or more): Nausea (up to 18.3%), diarrhea (up to 14%)
• Common (1% to 10%): Abdominal pain, constipation, dry mouth, dyspepsia, flatulence, indigestion, toothache, vomiting
• Uncommon (0.1% to 1%): Abdominal cramp, abdominal discomfort, belching, bloating, change in bowel habit, colitis, enteritis, epigastric discomfort, gastritis, gastrointestinal bleeding, gastrointestinal hemorrhage (including rectal hemorrhage), gastroesophageal reflux, hemorrhoids, heartburn, increased stool frequency, irritable bowel syndrome, melena, periodontal destruction, tooth disorder, ulcerative colitis, ulcerative stomatitis
• Frequency not reported: Gastroenteritis
• Postmarketing reports: Dysphagia, pancreatitis, stomatitis^[Ref]

Metabolic

• Common (1% to 10%): Decreased appetite, increased appetite, weight increased
• Uncommon (0.1% to 1%): Abnormal glucose tolerance, anorexia, carbohydrate craving, diabetes mellitus, gout, hypercholesterolemia, hyperglycemia, hyperlipidemia, thirst, weight decreased
• Frequency not reported: Hyponatremia
• Postmarketing reports: Hypoglycemia, hypokalemia^[Ref]

Numerous cases of hyponatremia have been reported following treatment with an SSRI. Risk factors for the development of SSRI- associated hyponatremia including advanced age, female gender, concomitant use of diuretics, low body weight, and lower baseline serum sodium levels have been identified. Hyponatremia tends to develop within the first few weeks of treatment (range 3 to 120 days) and typically resolves within 2 weeks (range 48 hours to 6 weeks) after therapy has been discontinued with some patients requiring treatment. The proposed mechanism for the development of hyponatremia involves SIADH via release of antidiuretic hormone.

A 62-year-old woman developed hyponatremia approximately 3- weeks after initiating treatment with escitalopram. Following discontinuation of the drug and administration of intravenous normal saline solution, the patient's serum sodium and serum and urine osmolality returned to normal levels.

In a similar case, hyponatremia developed in a 75-year-old woman five days after initiating treatment with escitalopram. Following discontinuation of escitalopram serum sodium levels returned to normal values over a period of 5 days. The authors suggest that the risk of hyponatremia is highest during the initial weeks of treatment and is higher in women than in men, in patients 65 years of age or older, and in patients receiving multiple drugs that may also cause hyponatremia.^[Ref]

Other

• Common (1% to 10%): Fatigue, pyrexia
• Uncommon (0.1% to 1%): Abscess, accidental injury, asthenia, bite, burn, deafness, earache, ear disorder, ear infection not otherwise specified, facial edema, fall, food poisoning, fractured neck of femur, hernia, inflicted injury (unintended injury), malaise, otitis externa, otosalpingitis, rigors, sting, surgical intervention, tinnitus, traumatic hematoma, vertigo
• Postmarketing reports: Injury not otherwise specified, spontaneous abortion^[Ref]

Genitourinary

• Very common (10% or more): Ejaculation disorder (up to 14%)
• Common (1% to 10%): Anorgasmia, decreased libido, ejaculation failure, impotence, menstrual disorder, vaginal bleeding
• Uncommon (0.1% to 1%): Amenorrhea, atrophic vaginitis, breast pain, cystitis, delayed ejaculation, dysmenorrhea, dysuria, genital infection, genital moniliasis, intermenstrual bleeding, loss of libido, menopausal symptoms, menorrhagia, menstrual cramps, metrorrhagia, micturition disorder, micturition frequency, nocturia, polyuria, postmenopausal bleeding, premenstrual tension, prostatic disorder, sexual function abnormality, unintended pregnancy, urinary frequency, urinary incontinence, urinary retention, urinary tract infection, uterine fibroid, vaginal candidiasis, vaginal hemorrhage, vaginitis
• Frequency not reported: Galactorrhea, priapism^[Ref]

Urinary retention and galactorrhea have been reported with other SSRIs. The estimates of the incidence of untoward sexual experience and performance may underestimate their actual incidence, partly because patients and physicians may be reluctant to discuss this issue.^[Ref]

Dermatologic

• Common (1% to 10%): Increased sweating
• Uncommon (0.1% to 1%): Acne, aggravated psoriasis, alopecia, cellulitis, dry skin, eczema, erythematous rash, fungal dermatitis, furunculosis, hematomas, lichenoid dermatitis, onychomycosis, pruritus, purpura, pustular rash, rash, scar, skin disorder, urticaria, verruca
• Frequency not reported: Angioedema, ecchymosis
• Postmarketing reports: Epidermal necrolysis, erythema multiforme, Stevens Johnson syndrome, toxic epidermal necrolysis^[Ref]

Angioedema has been reported with racemic citalopram.^[Ref]

Endocrine

• Frequency not reported: Inappropriate antidiuretic hormone secretion (SIADH)
• Postmarketing reports: Hyperprolactinemia^[Ref]

Hematologic

• Uncommon (0.1% to 1%): Anemia, hypochromic anemia, leucopenia
• Frequency not reported: Thrombocytopenia
• Postmarketing reports: Agranulocytosis, aplastic anemia, decreased prothrombin, hemolytic anemia, idiopathic thrombocytopenia purpura, increased INR^[Ref]

Hepatic

• Uncommon (0.1% to 1%): Bilirubinemia, hepatic enzymes increased
• Postmarketing reports: Abnormal liver function tests, fulminant hepatitis, hepatic failure, hepatic necrosis, hepatitis, increased bilirubin^[Ref]

Hypersensitivity

• Uncommon (0.1% to 1%): Aggravated allergy, allergic reactions
• Rare (less than 0.1%): Anaphylaxis/anaphylactic reaction
• Postmarketing reports: Hypersensitivity not otherwise specified, photosensitivity reaction^[Ref]

Immunologic

• Common (1% to 10%): Influenza-like symptoms
• Uncommon (0.1% to 1%): Bacterial infection, herpes simplex, herpes zoster, infection, moniliasis, parasitic infection, tuberculosis^[Ref]

Musculoskeletal

• Common (1% to 10%): Arthralgia, back pain, myalgia, neck/shoulder pain
• Uncommon (0.1% to 1%): Arthritis, arthropathy, arthrosis, bursitis, costochondritis, fibromyalgia, ischial neuralgia, jaw stiffness, leg pain, limb pain, leg cramps, lumbar disc lesion, muscle contractions, muscle cramp, muscle spasms, muscle stiffness, muscle tightness, muscle weakness, myopathy, osteoporosis, plantar fasciitis, tendinitis, tenosynovitis, tetany, twitching
• Postmarketing reports: Rhabdomyolysis^[Ref]

Epidemiological studies, primarily in patients aged 50 years or older, have shown an increased risk of bone fractures in patients receiving SSRIs or TCAs.^[Ref]

Ocular

• Uncommon (0.1% to 1%): Abnormal accommodation, abnormal vision, blepharospasm, blurred vision, dry eyes, eye infection, eye irritation, eye pain, mydriasis, ocular hemorrhage, visual disturbance, xerophthalmia
• Postmarketing reports: Angle closure glaucoma, diplopia^[Ref]

Oncologic

• Uncommon (0.1% to 1%): Cyst, female breast neoplasm, ovarian cyst^[Ref]

Renal

• Uncommon (0.1% to 1%): Pyelonephritis, renal calculus
• Postmarketing reports: Acute renal failure^[Ref]

Respiratory

• Common (1% to 10%): Pharyngitis, rhinitis, sinusitis, upper respiratory tract infection, yawning
• Uncommon (0.1% to 1%): Asthma, bronchitis, coughing, dyspnea, epistaxis, laryngitis, nasal congestion, nasopharyngitis, pneumonia, respiratory tract infection, shortness of breath, sinus congestion, sinus headache, sleep apnea, snoring, tracheitis, throat tightness
• Postmarketing reports: Pulmonary embolism, pulmonary hypertension of the newborn^[Ref]

Frequently asked questions

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Further information

Escitalopram side effects can vary depending on the individual. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Note: Medication side effects may be underreported. If you are experiencing side effects that are not listed, submit a report to the FDA by following this guide.

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