Lexapro: Uses and Side Effects of the High-Class Escitalopram
Escitalopram is a drug part of the selective serotonin reuptake inhibitors (SSRIs) group, used to treat depression and other mental disorders. Similar drugs in this family include sertraline, fluoxetine, paroxetine, and citalopram, a precursor to Lexapro (escitalopram).
The pharmaceutical companies H. Lundbeck A/S and Forest Laboratories create this medicine in 1997; they had previous experience since they gave origin to citalopram, another antidepressant drug similar to Escitalopram. However, it was not until 2012 that Lexapro gained strength and was marketed arduously. Today it is one of the SSRIs most used as an antidepressant and anxiolytic, although it has many uses in much other pathology.
Lexapro as SSRI
Although the mechanism of action is not properly known, SSRIs are the most frequently prescribed antidepressants. Scientists attribute its effectiveness in treating symptoms of anxiety and depression to the effect on the release of different monoamines: serotonin, noradrenalin, and dopamine.
These drugs increase the availability of the monoamines in the synaptic space (the space between each neuron) by limiting their absorption by post-synaptic receptors.
This means that we will have more neurotransmitters -which are missing in depression and anxiety- in the place where we need them most.
Furthermore, unlike other SSRIs, Escitalopram exerts its effect in a highly selective manner, unlike the rest of the drugs in its class; this means that its interaction with the receptors of other neurotransmitters is scarce, so we will not observe side effects, as much as with other drugs, resulting from undesirable stimulations.
Uses of Escitalopram
Like other SSRIs, Escitalopram is effective for treating multiple symptoms related to anxiety and depression, although not all countries have approved its use for the same disorders.
Let us look at the most common therapeutic uses of Escitalopram.
1.Major depressive disorder
Even when there are many types of depression, scientific research has shown the efficacy of Escitalopram in major depressive disorder treatment. In fact, thanks to the high effectiveness of this drug as an antidepressant, specialists have considered its use in other pathologies whose biological origin - the alteration of serotonin levels - is similar to that of depression, such as generalized anxiety disorder, obsessive-compulsive disorder and nervous bulimia.
The high selectivity of Escitalopram as an SSRI makes it an ideal mainstay to treat depression.
2.Generalized Anxiety Disorder
Generalized anxiety is an acute, consensual disorder that interferes with everyone’s daily activities. The therapeutic effects of Escitalopram in this disorder are significant and rapid; physicians will detect clear improvements in the condition of most patients approximately two months after starting treatment. You can function normally by the end of the third month, i.e., it will not interfere with your daily activities.
Panic disorder is characterized by the onset of panic attacks, during which symptoms such as tachycardia, shortness of breath, and fear of death arise. It may or may not be accompanied by agoraphobia. The Escitalopram, through the permanence of the serotonin in the synaptic space, allows you to react to your normal activities, that the organic effects of the panic attack disappear and that the number and frequency of the crises diminish importantly.
In social phobia, symptoms of anxiety associated with social interaction appear. In addition to antidepressants, doctors sometimes prescribe anxiolytics, particularly beta-blockers and benzodiazepines. An important point of treatment is also made up of psychotherapy; however, Lexapro is one of the most widely used medications.
Doctors use Escitalopram and some other SSRIs to treat obsessive-compulsive disorder or OCD, diagnosed when obsessive thoughts that cause anxiety are present and behavioral rituals that aim to reduce discomfort.
Side effects: The Common Denominator of Antidepressants
There is no perfect drug, even the newest antidepressants have important side effects, and Lexapro is no exception. Despite its high selectivity with serotonin receptors, it maintains some interactions with dopamine and noradrenalin receptors, which may explain some of its side effects. In addition, we can achieve a higher increase in serotonin levels, which can also be harmful.
However, although we want to improve fast and the drug to take effect soon, the first few weeks show very important and abrupt changes, which can sometimes, have very important undesirable effects.
Among the side effects of this drug, as well as most psychiatric medications, nausea and vomiting stand out. It is difficult to conclude the treatment with this drug without having this type of consequences. The gastrointestinal alterations are always frequent with any medication, apart from the above mentioned also highlights diarrhea and constipation. In addition, others are also frequent nasal mucous plugging and decreased or increased appetite.
Paradoxically, this medication -in specific cases- could also cause anxiety and agitation, although we can use it for these cases. Sleep disorders are frequent, importantly the inability to fall asleep, drowsiness, yawning, etc.
We make special mention of three important disorders:
1) Sexual alterations:Like most serotonin reuptake inhibitors, sexual dysfunctions are a very common side effect. You may experience a marked decrease in libido or sexual appetite, but also other effects related to sexual appearance such as genital anesthesia, excitement disorders, ejaculatory delay and anorgasmia (especially in women).
2) Hemorrhages: An adverse effect cataloged as infrequent (1 of every 1000 patients) presents with Escitalopram. In women, physicians relate it to abundant vaginal bleeding, especially during the days of menstruation, while nasal bleeding is frequent in men, even though women can suffer from it too.
3) Seizures: As mentioned above, we have to be especially careful if we are talking about patients with epilepsy. This is one of the less frequent adverse reactions present in some of the patients who use this drug.
Other less frequent adverse effects, but also present, are difficulty breathing, alterations of the heart rhythm, inflammation of the face, hands and ankles, increased sweating, muscle or joint pain, fatigue, fever, weight loss, aggression, hallucinations, and so on.
Considerations Before Taking Lexapro
Although it’s the best antidepressant, we can’t use it on just anyone. We are all different and have base conditions that alter the outcome of the use of this drug, so it is best to keep in mind under what conditions we may or may not use Lexapro.
We cannot use it under any circumstances when:
- Allergies: If you are allergic to this compound or similar compounds (such as citalopram) you may not use this medication. Allergic reactions to Lexapro can range from mild skin rashes to life-threatening complications, so be careful.
- MAO: The liver metabolize this drug thanks to the MAO enzyme, so check the drugs you take together in Lexapro and make sure that none of them inhibit that enzyme, because the Escitalopram will accumulate harmfully in your body.
- Pregnancy: there are other options in the case of pregnancy; however, Escitalopram is harmful to the baby. Many studies show the potential risk of persistent pulmonary hypertension during the third trimester of pregnancy with the use of Lexapro. On the other hand, it also increases the risk of postpartum hemorrhage, so the use of this drug during pregnancy is delicate. Talk to your doctor about other options and whether or not you should take Escitalopram.
Special cases with the Lexapro:
-Epilepsy:Tell your doctor if you have epilepsy or have had a seizure before, these are important facts that your doctor should know. The Lexapro - in a few cases - increases the frequency of seizures. If you do not suffer from epilepsy, but after using this drug experienced some type of seizure, temporary memory loss or sudden decay without explanation leave the medication.
-Hepatic/Renal Damage: If you suffer from any disease that may be altering your kidneys or liver, such as high blood pressure, consult your doctor. The kidney is the way of elimination of this drug and the liver is the one who metabolizes it, therefore, if these organs are affected we will accumulate harmfully this medicine in our organism. Your doctor will keep the prescription; however, the idea is to adjust the doses according to the damage to those organs.
-Diabetes: Lexapro can alter the blood glucose levels in your body, therefore, it is necessary to maintain strict control over glycemic measurements and adjust the doses of your medications.
-Hemorrhages: if you suffer from any type of bleeding disorder be careful, the Lexapro can increase it.
-Coronary illnesses: consult your doctor and explain the different pathologies that could affect your cardiovascular system, you must take important measures to avoid harmful complications.
Important facts and recommendations about using Lexapro
-Consult your health professional: do not try to take Escitalopram on your own, this drug is quite powerful and can cause you significant harm. Be honest with your doctor; tell him about each one of your pathologies, past illnesses, medicines you have used, etc. It may be essential to avoid the use of Lexapro. As mentioned above, patients with renal or hepatic alterations may be at particular risk, so your doctor may indicate some evaluations before the use of this medication to ensure that your kidney and liver are in optimal condition.
-Conception: It is better to avoid pregnancy as much as possible, the alterations and damages it causes on the baby are many and go beyond those previously mentioned, so it is better to avoid the use of this medicine to keep your health intact. Breastfeeding is also contraindicated, in fact, the alterations caused by Lexapro on prolactin, the hormone responsible for breast milk production, are quite important, so it is preferable that you do not breastfeed during that period of time.
-Duration and time: most people with major disorders, such as generalized anxiety or depression, expect rapid changes in their behavior or health status, however, most antidepressants take weeks or even months to take effect, so we recommend that you be patient and wait at least 2 weeks, the time in which you can see the first effects of Escitalopram. However, this time can vary depending on the patient and their sensitivity to this drug, so it is better not to despair and have patience, good changes take time.
-Children and adolescents: Physicians do not recommend the use of Lexapro in minors as it can contribute to powerful psychic side effects, such as hostility, suicidal thoughts, and suicide attempts. It is difficult to prescribe this type of medication in minors; however, your doctor may decide to do so if believes that it is in the best interest of the patient. However, if you see any unfavorable effects, discontinue use. There are other long-term effects not very well described among which we find alterations of growth, cognitive development, and mental maturity; however, they are few cases and are not statistically significant.
-Do not exceed the dose: even if you forget to take one pill, do not try to take two to replace the one you lost, SSRIs are dangerous drugs that we do not process in high doses, can be toxic and cause organ damage. If you unconsciously exceed the dose, consult your physician immediately or the toxicology service in your city. Some of the signs of intoxication are dizziness, vomiting, convulsions, headache, hydroelectrolyte and heart rhythm disturbances, as well as blood pressure.
-Treatment interruption: Escitalopram is like any other drug, you can’t stop it overnight, and it’s a time-consuming process. If you stop taking this medication abruptly, you will suffer from withdrawal symptoms, especially when you have taken Lexapro for a long time or when the doses you took were very high. Most patients report that these symptoms are short and rapid, not exceeding two weeks; however, in some patients it can last up to 2 months.
Some of the most frequent withdrawal symptoms include vertigo (sensation similar to dizziness), itching, tingling, sleep disturbances (the patient may sleep but does not rest, has very intense dreams), restlessness, confusion, rhythm disturbances, hallucinations, etc. In order to avoid these effects, you should not interrupt your medication abruptly; your doctor will gradually decrease the dose until you finally abandon the treatment completely.
Depression and anxiety are two psychiatric disorders that must be approached with many therapies and techniques; do not leave aside some options as good as Escitalopram just for its adverse effects. All drugs have unwanted effects; you must overcome them and start to improve.
Depression: When Should We Suspect of Sadness?
Over the years, the definition of Depression has changed enormously as has the way society recognizes this disorder. However, the only thing clear is that it is one of the most important pathologies of our time, and that undoubtedly, there will always be someone close to us with depression, so it is important to learn to recognize the symptoms and the evolution of this disease.
Depression is much more than being without moods or with low moods, it is a mental disorder characterized by feelings of sadness linked to alterations in behavior, activity and thinking. This disease affects not only the sufferer, but also the people around the affected.
This disorder is the first cause of attention in psychiatry, which appears more frequently in women especially if they are older than 45 years. In addition, it is the most frequent psychiatric pathology in primary care and the first origin of psychological disability.
The Origin of Depression
Depression is a disease of multifactorial origin, there is no single aspect or factor capable of triggering it by itself, but the interaction of all these factors must occur to give way to the origin of this terrible pathology.
Despite being a psychiatric disease, it has an organic component. Specialists have shown that there is an about 30% greater risk of suffering from depression if any immediate family member also suffered from that disease. Likewise, twin brothers -monozygotic or dizygotic- have a high percentage of suffering from depression if anyone suffers from it; this was the data of greatest weight in studies related to genetics and this disorder.
The level of serotonin is not only the origin of the disease but also the key point that determines the appearance and chronicity of this disorder. Therefore, any disease capable of altering the levels of this valuable neurotransmitter will cause depression.
There is a direct relationship between sex and depression since women are the most affected. Likewise, age is a determining factor; people from 35-45 years of age are usually the most affected. Pregnancy and postpartum are two important stages in any woman, which, in fact, can trigger depressive events.
Physicians consider that any activity, thought or negative action as potential events that can trigger this pathology, among them, we have stress, anxiety, personal problems, inability to reach goals, drugs, alcohol, etc.
How Do We Know When We Are Depressed?
To speak more simply about the symptoms of depression, let us explain its nucleus of this disease:
- Pathological sadness: besides what we know as sadness, we can speak of “pathological” when we combine it with the loss of attention, inability to control crying, low self-esteem and feelings of guilt.
- Decreased vitality: the ability to do new things, to move or try something, other than the actions necessary to live, no longer exists. We understand that we are very tired; we have an endless fatigue sensation not related to sleep, because, despite sleeping, we are still tired.
- Loss of interest: we refuse to perform any action or even have positive thoughts, negativism consumes us completely and changes our way of seeing the world. “What’s the point of doing it...?” or “why should it change...?” are some of the frequent thoughts that invade our mind.
Even if you suspect you have, or that someone close to you suffers from depression, only the medical specialist can diagnose it with certainty.
It takes more than a moment of absolute sadness or low mood to talk about depression. Even though the death of a close relative may be the trigger of depression, it does not mean that everyone who loses a loved one will be depressed. That differentiation is what your specialist should do.
In general, it is necessary to test the intensity of your symptoms, their duration (which is greater than 2 weeks) and the disability it generates over you, that is, whether or not it allows you to perform your daily activities normally. This is an important disease with a high degree of disability, so anyone who suffers it will surely change their routine and behavior.
Among the techniques performed:
1) Diagnostic interview: your doctor uses it to get to know you and find the possible traits or factors originating from the disease.
2) Organic discard: as mentioned above, many other diseases can cause depression because of their effect on serotonin levels, so it is necessary to perform blood tests and other studies to rule out the possibility that there are other associated pathologies.
3) Psychodiagnostic tests: the definitive tool that will give your doctor the greatest certainty in the diagnosis.
Treatment: Beyond Pharmaceuticals
Depression is a multifactorial disease approached from any possible point of view, for that, although pharmaceuticals are the best-known alternative, we have various techniques and therapies. Let us talk a little about each one:
The first and most talked about are the drugs used for depression. The most important is the group of selective serotonin reuptake inhibitors (SSRIs), which allow this neurotransmitter to occupy the synaptic space for a longer time, allowing serotonin to maintain its levels -which decrease in depression- so that we can maintain a positive mood.
Unfortunately, they all have side effects that can be harmful and it is necessary for your doctor to alternate between each of them in order to get the one that suits you best. Despite these effects, it is necessary that you stick to and maintain the treatment; your doctor will give you other drugs and methods to avoid or diminish the intensity of these undesirable effects.
Similarly, your doctor will watch you closely and will ask for support from family or friends, since these drugs can have dangerous effects on your health, not only physically, but also even psychologically, where even suicidal ideas may appear.
This is a fundamental pillar in any therapy; your specialist will try to develop his style of therapy in you, either through analysis or changes in behavior. Doctors try to get to the source of the conflict and treat it, and for that, they use different schemes and methods that can take several sessions. In addition, talking about your problems generates satisfaction and a feeling of happiness; you are being cared for and understood by a person who cares about your health.
Your family is part of the progress, they will be those who avoid your isolation and collaborate with your feeling of deep sadness, so your doctor can perform therapies that involve them or directly involve the conflict or origin of the problem.
Do not be afraid to express your feelings, understand that although pharmaceuticals are a fundamental part of treatment, psychotherapy is the ideal complement to it. With psychotherapy they will offer you security, confidence, understanding and emotional support, they will correct your thoughts, they will explain your situation so that you will be calm, and they will teach you to avoid relapses.