With this post, we continue our biweekly series on medications used to treat bipolar disorder and related symptoms. We have already covered lithium, along with anti-seizure and atypical antipsychotics commonly used as anti-manic medications or mood stabilizers in bipolar disorder. We introduced our coverage of SSRI (Selective Serotonin Reuptake Inhibitor) antidepressants with a post on Prozac (fluoxetine). This week, we continue our series on SSRI antidepressants with this post on Lexapro (escitalopram).
As a group, the SSRI’s share many of the same potential benefits and potential negative side effects, so we encourage you to read the Prozac post first to get up to speed about general information relating to SSRI’s, including how SSRI’s work and important cautions about using any antidepressant to treat depression in bipolar. In this post, we focus on Lexapro’s profile in treating bipolar depression and depression in general.
Lexapro’s potential benefits are in line with those of other SSRI’s. It has been approved for treatment of depression and certain anxiety conditions in patients 18 years and older:
Lexapro may also be useful in treating other anxiety and mood disorders, including the following:
Typical doses of Lexapro range from 10 mg to 20 mg taken once daily, higher in some cases, same time each day, but follow your prescriber’s recommendations on dose and when to take it.
Like most medications in its class, Lexapro can potentially cause any of several negative side effects. The most serious are the following:
Other less serious side effects can include the following (Note: Many of these side effects are transient and occur when first taking these medications but do not persist.):
Remember: Any antidepressant can take 2-3 weeks or even longer to become fully effective; it may take several weeks to work up to a therapeutic dose. This means that your depression may not lift for several weeks. I often tell patients that however they feel in the first two weeks is unlikely to be how they feel in a month – so if they are feeling some early side effects, hold on because they will likely get better. Patience is important in getting these medications to work, but if you have any concerns about how you are feeling, you should contact your doctor. You will most likely have a follow-up visit with your doctor within a month or less of starting the medications; this is a good time frame for checking in to see if benefits have started or if side effects have faded or persisted.
Lexapro is closely related to the medication, Celexa (Citalopram). Citalopram is made up of two types of molecules that are mirror images of each other. Lexapro is made up of only one of the mirror images. It has been marketed as “cleaner” due to this molecular structure, and the implication has been that it would have fewer side effects than Celexa. In general Lexapro runs about the same risks of side effects as other SSRI’s. The differences in positive and negative responses to the various medications appear to be more related to any one individual’s brain and body wiring rather than the subtle differences between some of these medications.
Lexapro has FDA indications for major depression and generalized anxiety disorder, although it’s used extensively for other types of depression and anxiety. It has no specific indications for use in bipolar depression. I have a number of patients on it, but in general I have it further down my list simply because the older medications are effective and well tolerated, so I don’t have to proceed this far down the list. Once I have tried two or three SSRI’s, it usually means I will move on to another class of medications. But I certainly have many patients on Lexapro who have improvement in symptoms and minimal side effects. It is a good medication, just kind of an additional option in my play book.
For more about Lexapro, visit Forest Pharmaceuticals’ Lexapro page.
If you’ve taken any form of Lexapro for bipolar depression or are a doctor who has prescribed it, please share your experiences, insights, and observations.
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Last reviewed: 3 Apr 2009