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What is Lexapro?

Lexapro, or escitalopram, is a popular serotonin-norepinephrine reuptake inhibitor (SNRI) drug primarily prescribed for the treatment of depression. SNRIs are also sometimes used for treating anxiety, diabetic neuropathy, or chronic fibromyalgia pain. While people have found varying degrees of success using Lexapro to treat depression, the effects of long-term use (and subsequent withdrawal) are poorly understood and can be potentially serious.

One of the more concerning facts about drug-based mental health treatment is that while pharmaceutical companies have proposed data to show that SNRIs can help combat the symptoms of depression in some people, we have a very limited understanding of how exactly this mechanism works, why so many patients fail to see results or the health consequences of long-term SNRI treatment.

About Long-Term SNRI Use

So, can you take Lexapro for years? Certainly, some people do, with varying degrees of success, and pharmaceutical companies will tell you it’s perfectly safe. The reality, however, is that we just don’t know everything there is to know about the long term consequences of daily Lexapro use. As of now, we can’t definitively say whether Lexapro can cause permanent damage to a particular person’s mental or physical health.

During a 2017 SNRI study in China, fully one-third of the patients involved dropped out of the study completely before it was finished. 1 SNRIs like Lexapro usually don’t start working in any tangible way until the medicine has built up in your body over time, often as your doctor continuously increases the dosage to reach a therapeutic level. Once that level is reached, some patients experience relief from depression symptoms.

However, the changes these powerful drugs can inflict on your system with this constant schedule of re-dosing are not all positive, mood-boosting effects. This can be especially true when you continue to increase your dosage over months or years, and even more so if you should try to quit taking Lexapro.

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Unfortunately, some of the research and anecdotal evidence collected to date has revealed disturbing trends.

Observed long-term side effects of Lexapro include:

  • Weight Gain – For many patients, long term antidepressant treatment goes hand in hand with weight gain. In more extreme cases, this can feed back into a loop of negative feelings about one’s own body and health, exacerbating depressive symptoms and thought patterns.
  • Heightened Carcinoembryonic Antigen levels – CEA levels are used as an indicator for certain types of cancer.
  • Insomnia – Some users report significant disruption to their sleep patterns after starting a long-term antidepressant regimen.
  • Emotional Numbness – While antidepressants can be effective at chilling negative thought patterns like negativity and despair, they can also desensitize your other emotions. Long term antidepressant users sometimes report an inability to feel “real” happiness or even a loss of interest in their close relationships.
  • Sexual Dysfunction – A high percentage of antidepressant patients report reduced sex drive and problems with sexual performance.
  • Addiction – Long term antidepressant patients sometimes feel concerned that they are becoming addicted or chemically dependent; the sometimes-severe withdrawal episodes experienced by people who attempt to quit SNRIs or SSRIs “cold turkey” validates this concern.
  • Suicidal Thought Patterns – One of the most concerning things about Lexapro and other antidepressants in its class is that a significant number of patients actually experience an increase in suicidal thoughts instead of relief from depressive symptoms.

Quitting Lexapro

If you’re already on a high dose of Lexapro or generic escitalopram and have decided to end treatment, never attempt to do so cold turkey. Just as you build up the drug in your system gradually to start achieving its effects, you will need to reduce your dose slowly over time so that your body can adjust.

Unfortunately, withdrawal from Lexapro and other antidepressants can constitute some of their most extreme and unpleasant side effects. Withdrawal can potentially create a scary and drawn-out ordeal for someone who decides Lexapro just isn’t working for them after titrating up to a higher dose, as prescribed by their doctor.

What Are the Mental Side Effects of Lexapro?

Mental Side Effects of Lexapro

The mechanism by which Lexapro and other SNRIs act upon the brain, in simplified terms, is to force the brain to retain certain neurotransmitters. Clinical trials seem to suggest that SNRIs and SSRIs (another common and related class of antidepressant medication) may reduce some symptoms of depression in some patients, but we still lack a solid understanding of why this is. Perhaps more importantly, we don’t understand why it doesn’t work consistently across all patients and for all symptoms.

Because we don’t understand exactly how the inhibition of serotonin-norepinephrine reuptake would regulate someone’s mood in a positive and stabilizing way, we can’t even say definitively that forcing the brain to retain these neurotransmitters can actually reduce the symptoms of depression. That can be an unnerving prospect for patients prescribed these medications.

Measuring the efficacy of these drugs through clinical studies has not yet led to a complete understanding of how they work, nor their long-term side effects. The possibility exists that SNRIs are a risky pharmaceutical “hack” that does not cure depression and anxiety at all, but merely works to mask the symptoms of depression in some patients, and only some of the time.

SNRI treatment is a long-term maintenance project rather than a pharmaceutical “cure” much like an antiviral or antibiotic that you would stop taking after your infection has cleared up. SNRIs are also not a fast-acting medication to manage symptoms when they arise, such as an inhaler for asthma attacks or benzodiazepines for episodes of acute anxiety.

That Lexapro and other SNRIs are prescribed in this way says several alarming things about how they work:

  • Lexapro doesn’t really work at all until you’ve been taking it a while and have allowed it to build up in your system.
  • Lexapro continues affecting your system daily, even if you aren’t feeling the symptoms of depression and don’t feel the need for medication.
  • Lexapro often only works for as long as a patient continues to take it; stopping treatment is also a long-term commitment as withdrawal symptoms can be serious.
  • Long-term SNRI treatment often means gradually increasing the dose to adjust for tolerance over time. A patient with serious underlying mental issues may eventually find themselves taking the highest approved dose of Lexapro while no longer feeling any real benefit from it and will then be faced with the equally daunting prospects of switching medications or attempting to get off a high dose of Lexapro.

A 2013 study set out to determine why neurotransmitter targeting medicines like Lexapro left the majority of patients with at least one serious symptom of depression. 2 The study’s conclusions were less than inspiring for those patients using SNRIs or SSRIs and still struggling with symptoms of depression.

Among the study’s key clinical points: “Effective strategies” for dealing with these persistent symptoms were identified as “switching to a different antidepressant” as well as “adding adjunctive medications.” The problem with this approach is self-evident. Patients who feel let down — or even worse off — after trying SNRIs are understandably very hesitant to add additional medications or try another similar strategy.

What Are the Bad Side Effects of Lexapro?

A 2015 project attempted to weigh the clinical value of different antidepressant types against their most notable and commonly reported side effects. 3

Some of the most concerning side effects linked to SNRIs in this paper include:

  • Increased anxiety, especially early in the treatment cycle
  • Insomnia and general restlessness
  • Headaches
  • Sexual dysfunction or reduced sex drive
  • High blood pressure

Frequently Asked Questions about Lexapro Side Effects

New patients prescribed SNRI treatment will have a great deal of questions. These are the most common.

Q: Will I Gain Weight on Lexapro?

A: As it turns out, yes, it is fairly typical for patients to gain a small to moderate amount of weight when starting SNRI treatment. More uncommonly, starting Lexapro can cause changes in appetite that can also lead to weight changes.

Q: Is Lexapro Hard on the Liver?

A: Unfortunately, many medications can take a toll on the liver, including Lexapro. Even acetaminophen, the active ingredient in Tylenol and one of our most commonly ingested medications, is toxic to your liver. Your liver works hard to keep toxins filtered from your body, and when it must deal with daily doses of chemicals over a long period, the situation can become analogous to the overworked liver of an alcoholic. Remember the long standing wisdom: too much of any medicine constitutes a poison.

Q: Is Lexapro Linked to Dementia?

A: There is currently no data available to conclusively link Lexapro to dementia. However, the powerful way SNRIs work to change brain chemistry has some researchers concerned about the potential for Lexapro and other SNRI drugs to lead to long-term brain damage.

Q: What Should I Avoid While Taking Lexapro?

Besides being a powerful medicine in its own right, there are a number of other medicines and supplements that are best avoided when you’re on an escitalopram regimen.

These include:

  • Fentanyl
  • Buspirone
  • Lithium
  • Tryptophan
  • Amphetamines (including Adderall)
  • St. John’s Wort
  • Imitrex
  • Tramadol
  • Zomig

This is by no means an exhaustive list of medications that can interact with Lexapro. If you’re ever uncertain about taking another prescription drug or over the counter medication while on Lexapro, reach out to your doctor for clarification before making any decisions that could risk your health.

Ceasing Lexapro Use

When a patient feels uncomfortable taking Lexapro, or it doesn’t seem to be helping their depression, they will naturally have questions about ceasing use, especially if they’ve read or heard horror stories about antidepressant withdrawals from those who have stopped taking them abruptly. If you’re ready to end your Lexapro treatment, you may have all sorts of questions and concerns. Here are some of the most common.

Can Lexapro Cause Brain Fog?

Yes. Brain fog is a common symptom for many patients, both when starting Lexapro and when entering the withdrawal process. Much like Lexapro’s therapeutic function, it is unknown how exactly this occurs. A 2014 study of escitalopram’s mechanisms concluded that the drug not only “changes brain architecture” but can do so in just a matter of hours. 4

How Long Can I Stay on Lexapro?

This is between you and your doctor, and ultimately will be your own deeply personal decision about your health. If you decide you are uncomfortable taking Lexapro, feel it isn’t working for you, or would like to try treatments that rely less on powerful and poorly understood pharmaceuticals, be up front with your health providers about your concerns and intentions.

Can Lexapro Change Your Personality?

This question cannot be easily answered because “personality” is a fluid, philosophical concept rather than something with a firm medical definition. If personality can be defined as the average of someone’s mental and emotional state over time, then you might easily argue that the entire point of treatment with escitalopram and other antidepressants is, in fact, to change someone’s personality permanently. Whether medicinally altering someone’s personality constitutes an ethical “cure” for depression is another philosophical debate in and of itself.

How Can I Get Off Lexapro Naturally?

Unfortunately, it is dangerous to simply quit taking Lexapro, especially if you’re taking a high dose or have been on it for a long time. Quitting Lexapro and similar drugs should always involve working with a medical professional on a comprehensive plan to slowly reduce your dose over time. Some of the natural strategies former Lexapro patients have turned to for managing withdrawals and clinical depression range from probiotics and CBD to yoga and art therapy. Just like mental health struggles themselves, the best treatments can be a deeply personal matter that varies from patient to patient.

Why Shouldn’t You Stop Taking Lexapro Suddenly?

While the side effects of taking Lexapro can be significant, some of the worst negative side effects have actually been reported by patients who attempt to quit Lexapro “cold turkey” and suffer the harsh effects of escitalopram leaving their body too abruptly.

British psychologist, researcher, and author, Dr. Joanna Moncrieff once noted that the symptoms of withdrawal are often quite similar to those of depression itself, creating a sort of futile, harmful spiral for clinically depressed patients who don’t respond well to SNRI treatment. This doubling down of depressive symptoms can be a brutal realization for someone who has struggled with serious depression and then comes to realize their Lexapro treatment isn’t working for them.

Does Lexapro Damage the Brain?

The most concerning aspect of extended treatment with Lexapro and other SNRIs is that it may actually worsen depression in the long run, defeating the purpose of treatment entirely. Studies comparing the short- and long-term use of these sorts of antidepressants over time could not produce any evidence to support using SNRIs over an extended period, and, in fact, actually increased the risk of relapse in chronically depressed patients.

A 2016 study suggests that this may be due to long-term SNRI treatment causing heightened levels of carcinoembryonic antigen in patients’ bloodstreams. 5 This is yet another mechanism of Lexapro and SNRI antidepressants that is yet to be fully understood.

Lexapro Alternatives

Lexapro Alternatives

If you’re looking for a way out of an unsuccessful cycle of antidepressant treatment, tolerance, and withdrawal that never seems to truly overcome your depression symptoms, you aren’t alone. Many people with persistent symptoms of depression are looking for Lexapro alternatives.

Some of the most promising options include:

  • Non-medicinal counseling and therapy
  • A focus on healthy eating, testing for food allergies, and gut microbe health
  • Herbal supplements like valerian, kava, and St. John’s Wort
  • Omega-3 fatty acids (try fish, nuts, and seeds) and other amino acids important to mental health (leafy greens, raw fruits, quality animal proteins)
  • Vitamins D and B (sunlight is a great source of Vitamin D if you prefer to avoid lab-produced supplements)
  • 5-HTP (5-hydroxytryptophan) is involved in serotonin production and occurs naturally in poultry, leafy greens, and certain vegetables
  • Meditation, yoga, mindfulness exercises, etc.
  • Acupuncture, massage, and other “alternative” therapies shown to improve mood
  • Exercise

Get Alternatives to Lexapro

Seek help to create and implement a plan to taper your Lexapro regimen safely and effectively. Medical, psychotherapeutic and holistic therapies provide you with the natural alternatives required to overcome a dependence on hazardous medications.


Sources:

  1.  Jiang, K., Li, L., Wang, X., Fang, M., Shi, J., Cao, Q., He, J., Wang, J., Tan, W., & Hu, C. (2017). Efficacy and tolerability of escitalopram in treatment of major depressive disorder with anxiety symptoms: a 24-week, open-label, prospective study in Chinese population. Neuropsychiatric disease and treatment, 13, 515–526. https://doi.org/10.2147/NDT.S120190
  2.  Blier, P. (2013). Neurotransmitter targeting in the treatment of depression. The Journal of clinical psychiatry, 74(suppl 2), 12763. Retrieved 5/6/22 from https://www.psychiatrist.com/jcp/depression/neurotransmitter-targeting-treatment-depression/
  3.  Santarsieri, D., & Schwartz, T. L. (2015). Antidepressant efficacy and side-effect burden: a quick guide for clinicians. Drugs in context, 4, 212290. https://doi.org/10.7573/dic.212290
  4.  Schaefer, A., Burmann, I., Regenthal, R., Arélin, K., Barth, C., Pampel, A., … & Sacher, J. (2014). Serotonergic modulation of intrinsic functional connectivity. Current Biology, 24(19), 2314-2318. https://doi.org/10.1016/j.cub.2014.08.024
  5.  Ceylan, M. E., Evrensel, A., & Önen Ünsalver, B. (2016). Long-Term Use of Escitalopram and a High Level of Carcinoembryonic Antigen. Korean journal of family medicine, 37(6), 359. https://doi.org/10.4082/kjfm.2016.37.6.359


This content has been reviewed and approved by a licensed physician.

Dr. Samuel Lee

Dr. Samuel Lee is a board-certified psychiatrist, specializing in a spiritually-based mental health discipline and integrative approaches. He graduated with an MD at Loma Linda University School of Medicine and did a residency in psychiatry at Cedars-Sinai Medical Center and University of Washington School of Medicine in Seattle. He has also been an inpatient adult psychiatrist at Kaweah Delta Mental Health Hospital and the primary attending geriatric psychiatrist at the Auerbach Inpatient Psychiatric Jewish Home Hospital. In addition, he served as the general adult outpatient psychiatrist at Kaiser Permanente.  He is board-certified in psychiatry and neurology and has a B.A. Magna Cum Laude in Religion from Pacific Union College. His specialty is in natural healing techniques that promote the body’s innate ability to heal itself.

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Your Guide to the Long-Term Effects of Lexapro
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