Escitalopram Side Effects

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

Applies to escitalopram: oral solution, oral tablet.

Precautions

It is very important that your doctor check your progress at regular visits to allow for changes in your dose and to help reduce any side effects. Blood tests may be needed to check for any unwanted effects.

Do not take escitalopram with a monoamine oxidase (MAO) inhibitor (eg, isocarboxazid [Marplan®], linezolid (Zyvox®), methylene blue injection, phenelzine [Nardil®], selegiline [Eldepryl®], tranylcypromine [Parnate®]). Do not start taking escitalopram during the 14 days after you stop a MAO inhibitor. Wait 14 days after stopping escitalopram before you start taking a MAO inhibitor. If you take them together or do not wait the proper amount of time, you may develop confusion, agitation, restlessness, stomach or bowel symptoms, a sudden high body temperature, an extremely high blood pressure, or severe seizures.

Do not take escitalopram with pimozide (Orap®). Using these medicines together can cause very serious heart problems.

Escitalopram may cause some teenagers and young adults to be agitated, irritable, or display other abnormal behaviors. It may also cause some people to have suicidal thoughts and tendencies or to become more depressed. Some people may have trouble sleeping, get upset easily, have a big increase in energy, or start to act reckless. If you or your caregiver notice any of these unwanted effects, tell your doctor right away. Let the doctor know if you or anyone in your family has bipolar disorder (manic-depressive) or has tried to commit suicide.

Check with your doctor right away if you or your child have anxiety, change or loss of consciousness, confusion as to time, place, or person, diarrhea, dizziness, dry mouth, extremely high fever or body temperature, holding false beliefs that cannot be changed by fact, hyperventilation, increased sweating, irregular heartbeats, irritability, muscle cramps, muscle twitching or jerking, nausea, pale, clammy skin, nervousness, redness of the face, neck, arms and occasionally, upper chest, restless, rhythmic movement of muscles, seeing, hearing, or feeling things that are not there, shakiness in the legs, arms, hands, or feet, trembling or shaking of the hands or feet, trouble breathing, trouble sleeping, or vomiting. These may be symptoms of a serious condition called serotonin syndrome. The risk may be higher if you or your child also take certain other medicines that affect the serotonin levels in the body. Do not use escitalopram with buspirone (Buspar®), fentanyl (Abstral®, Duragesic®), lithium (Eskalith®, Lithobid®), tryptophan, St. John's wort, amphetamines, or some pain or migraine medicines (eg, meperidine, methadone, rizatriptan, sumatriptan, tramadol, Demerol®, Frova®, Imitrex®, Maxalt®, Methadose®, Relpax®, Ultram®, Zomig®). Check with your doctor first before taking any other medicines with escitalopram.

Do not suddenly Stop taking escitalopram without checking first with your doctor. Your doctor may want you to gradually reduce the amount you are taking before stopping it completely. This will decrease the chance of having withdrawal symptoms such as increased anxiety, burning or tingling feelings, confusion, dizziness, headache, irritability, nausea, trouble sleeping, or unusual tiredness or weakness.

This medicine may increase your risk for bleeding problems. Make sure your doctor knows if you are also taking other medicines that thin the blood, including aspirin, NSAIDs (eg, diclofenac, ibuprofen, naproxen, Advil®, Aleve®, Celebrex®, Voltaren®), or warfarin (Coumadin®, Jantoven®).

This medicine may cause hyponatremia (low sodium in the blood). This is more common in elderly patients, those who are taking diuretic medicines for high blood pressure, or those who have decreased amounts of fluid in the body due to severe diarrhea or vomiting. Check with your doctor right away if you have confusion, headache, memory problems, trouble concentrating, weakness, or unsteadiness.

This medicine may cause some people to become drowsy, have trouble with thinking or controlling body movements. Make sure you know how you react to escitalopram before you drive, use machines, or do anything else that could be dangerous if you are not alert or well-coordinated.

The use of alcohol is not recommended in patients who are taking escitalopram.

Check with your doctor right away if you have decreased interest in sexual intercourse, delayed or inability to have an orgasm in women, inability to have or keep an erection in men, or loss in sexual ability, desire, drive, or performance. These could be symptoms of sexual dysfunction.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal (eg, St. John's wort) or vitamin supplements.

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:

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:

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]

See also:

Frequently asked questions

• Why does Lexapro cause weight gain?
• SSRIs vs SNRIs - What's the difference between them?
• When is the best time to take Lexapro?
• How long does it take for Lexapro to work?
• Does Lexapro cause night sweats?
• What is the difference between Celexa and Lexapro?
• On Nexito plus for 3 months, stopped 2 days ago, can't sleep. Why?
• What are some common side effects of antidepressants?

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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