Table of Contents

Lexapro is the brand name for escitalopram, a type of antidepressant that belongs to a group of drugs called selective serotonin reuptake inhibitors (SSRIs). It’s approved to treat major depressive disorder in adults and teens aged 12 to 17, and for generalized anxiety disorder in adults and in children 7 years and older.

Doctors sometimes use Lexapro for other conditions not officially approved for it. These “off-label” uses include social anxiety disorder, obsessive-compulsive disorder (OCD), panic disorder, post-traumatic stress disorder (PTSD), premenstrual mood problems, and hot flashes related to menopause.

It can be effective and well tolerated, yet it still brings side effects that matter to women at different life stages, from puberty through menopause, pregnancy, and breastfeeding.

This guide explains what to expect, why side effects occur, how often they happen, and how to manage them safely.

Key Takeaways

  • Compared with older drug classes, Lexapro tends to cause fewer side effects and drug interactions, making it a common first-line treatment for depression and anxiety disorders.
  • Nausea, trouble sleeping, fatigue, and low sex drive often occur early in treatment and tend to fade as the body adjusts.
  • Conditions like serotonin syndrome, low sodium, or heart rhythm problems can occur, especially when combining Lexapro with other medications that affect serotonin.
  • While uncommon, Lexapro can sometimes cause menstrual changes, breast pain or discharge, or elevated prolactin levels, which usually resolve after stopping the medication.
  • Many users experience decreased libido or delayed orgasm, which can persist even as mood improves and may need medical adjustment or a medication switch.
  • Long-term users may gain a small amount of weight, though this varies and is typically less pronounced than with certain other antidepressants.
  • Pregnant and postpartum women need closer monitoring. SSRIs, including Lexapro, may slightly increase the risk of postpartum hemorrhage, particularly at higher doses, so dosage and timing should be carefully managed.

How does Lexapro work in the body?

SSRIs, like Lexapro, work by increasing the amount of serotonin, a chemical messenger that helps regulate mood and emotions, in the brain. Normally, after serotonin is released into the space between brain cells (called the synaptic cleft), a transporter protein called SERT pulls it back into the sending cell to be reused.

Lexapro blocks this transporter (SERT), which means serotonin stays in the space longer. This helps strengthen communication between brain cells that use serotonin and can improve mood, reduce anxiety, and help with emotional balance.

Lexapro (Escitalopram)

Serotonin, sometimes called 5-HT, affects many parts of your life, how you feel, think, eat, sleep, and even respond to stress or sexual desire. It acts through different serotonin receptors located in parts of the brain that control emotion, memory, and motivation, such as the cortex and limbic system.

Scientists have identified 15 types of serotonin receptors, and not all are in the brain. Some are also found in other body systems, like the gut, which is why Lexapro can sometimes cause digestive side effects.

What are the most common side effects of Lexapro?

Although escitalopram is generally safer than older antidepressants, it can still cause side effects. The most common ones include:

    • trouble sleeping
    • nausea
    • tiredness
    • somnolence
    • increased sweating
    • low sex drive
    • difficulty reaching orgasm
    • delayed ejaculation

Most of these are mild to moderate and may improve over time.

What are the serious side effects of Lexapro?

Some Lexapro side effects are less common but can be serious and may need medical attention. These include:

Low sodium levels

Escitalopram can sometimes cause a condition called SIADH, where the body holds on to too much water and lowers sodium levels in the blood. This happens more often in older adults.

Symptoms can start mild, such as loss of appetite, nausea, or headache, but if sodium drops too much, it can cause confusion, seizures, or even coma.

Heart rhythm changes

In rare cases, escitalopram can affect the heart’s electrical rhythm, shown on an ECG as QT prolongation. This means the heart takes longer than normal to recharge between beats, which can sometimes lead to dangerous rhythm problems like torsades de pointes (a type of irregular heartbeat).

The risk is higher in people who:

    • Are 65 years or older
    • Are female
    • Have low potassium, calcium, or magnesium levels
    • Have heart disease or heart failure
    • Take higher doses of escitalopram or other medications that affect heart rhythm

Serotonin syndrome

This is caused by too much serotonin in the brain and body. It usually happens when someone takes high doses or combines escitalopram with other serotonin-boosting medicines, like MAOIs, triptans, or some herbal supplements such as St. John’s Wort.

Symptoms can include:

    • Fast heart rate, high blood pressure, sweating, dizziness, and fever
    • Nausea, vomiting, diarrhea
    • Restlessness, confusion, or hallucinations
    • Muscle stiffness, tremors, shaking, or jerking movements

In severe cases, it can cause seizures, very high fever, or loss of consciousness. Doctors recommend waiting about four weeks after stopping escitalopram before starting another antidepressant that affects serotonin, to avoid this risk.

Other serious side effects

Some serious effects are not directly caused by Lexapro itself but may occur in certain situations, such as when the drug is taken with other medications or if you already have an underlying condition. These include:

    • Activation of mania or hypomania – may occur in people with bipolar disorder.
    • Increased risk of bleeding – more likely if you also take aspirin, NSAIDs, blood thinners (like warfarin), or other antiplatelet drugs.
    • Angle-closure glaucoma – can happen in people with anatomically narrow eye angles who do not have a patent iridectomy (a small opening in the iris that helps fluid drain).
    • Severe allergic reactions – may occur if you are allergic to escitalopram, citalopram, or any of the inactive ingredients in the medicine. Symptoms can include swelling of the face, lips, tongue, or throat, difficulty breathing, or severe skin rash.

Mood monitoring and suicide-related warnings

Escitalopram, like other antidepressants, carries an FDA boxed warning about the risk of suicidal thoughts and behaviors in children, adolescents, and young adults.

Extra check-ins are recommended when starting or changing the dose. Loved ones should speak up if they notice sudden mood shifts, agitation, or worsening depression. The official drug information spells out this precaution and urges close monitoring early in treatment and after dose changes.

What are the side effects of Lexapro in women?

Woman showing signs of depression or anxiety with her head in hands

While Lexapro helps many women manage anxiety and depression, it can also cause side effects that range from mild to, rarely, more serious. Knowing what to expect makes it easier to recognize what’s normal and when to call your doctor.

1. Sexual dysfunction

Sexual side effects are quite common with antidepressants like Lexapro. They can affect sexual desire, arousal, natural lubrication, and the ability to reach orgasm. In clinical trials, 3% of women treated with Lexapro experienced decreased libido, and another 3% experienced delayed or absent orgasm.

In one study, escitalopram 10-20 mg daily for 8 weeks improved sexual satisfaction in both men and women whose depression symptoms also improved. However, for women, even though they felt emotionally better, their sexual function, like desire, arousal, and orgasm frequency, did not improve.

Research involving nondepressed midlife women who used escitalopram to manage menopausal hot flashes found that the medication did not worsen overall sexual function compared with placebo. There was, however, a slight reduction in lubrication scores among women taking escitalopram.

Interestingly, while SSRIs often lower sexual desire, a few individuals may experience the opposite effect, possibly due to complex changes in serotonin and dopamine activity in the brain.

In a case report, a 25-year-old woman was diagnosed with severe depression (without psychotic symptoms). She began taking escitalopram 5 mg daily, which was increased to 10 mg after one week and then to 15 mg after two months when her improvement plateaued.

Within five days of the dose increase, she developed unusually high sexual desire and persistent sexual thoughts. This sudden change caused her severe emotional distress, along with restlessness, crying spells, and continued suicidal thoughts.

Her doctors stopped escitalopram and switched her to another antidepressant. Within two to three weeks, her symptoms eased significantly, suggesting that escitalopram triggered the reaction.

2. Breast pain, breast milk discharge, and high prolactin levels

A few case reports have described unusual breast-related side effects in women taking Lexapro, including breast milk discharge (galactorrhea) and breast pain (mastalgia). In some cases, this occurred along with elevated prolactin levels, which is a hormone that influences both the breasts and menstrual cycle.

In one report, a 24-year-old woman was diagnosed with an anxiety disorder and started on escitalopram 10 mg daily, along with a small dose of clonazepam (0.5 mg daily) to help her adjust to the treatment. The clonazepam was slowly reduced over two weeks.

After one month, her panic attacks had greatly improved, but she developed a whitish discharge from both breasts, a condition called galactorrhea. Her blood tests, including prolactin levels, were completely normal.

Another report described a 36-year-old woman who was diagnosed with major depressive disorder and prescribed escitalopram 10 mg daily. Her depression started to improve within two weeks. However, on day 14 of treatment, she developed galactorrhea along with breast pain.

Her breast ultrasound and mammogram were normal, but her serum prolactin level was very high (200 ng/mL), far above the normal range of 1.2-24.2 ng/mL. Other blood tests, including thyroid and metabolic panels, were normal.

A third case involved a 24-year-old college student who was diagnosed with depressive disorder and prescribed escitalopram 10 mg daily. After one month on escitalopram, she noticed breast pain and swelling, along with a white, milky discharge from both breasts. The discharge gradually increased, and the breast discomfort became more noticeable.

On examination, both breasts were swollen but not tender, and milky discharge appeared when pressure was applied.

Across all these reports, the side effects improved or completely disappeared once escitalopram was discontinued, suggesting a likely connection between the drug and these rare reactions.

3. Menstrual cramps and menstrual disorders

Most women don’t notice any changes in their periods when taking escitalopram. That said, premarketing evaluation of Lexapro reported:

    • unexpected bleeding
    • missed periods
    • menstrual cramps
    • vaginal bleeding that happens outside the regular cycle (metrorrhagia)

One case describes a 34-year-old woman who developed panic attacks due to stress at work and home. Her doctor added escitalopram 10 mg daily to her treatment, increasing it to 20 mg after three months to manage her symptoms.

About one month after the dose increase, she reported missing her period (amenorrhea) and took a home pregnancy test, which showed a false positive result. However, a lab-based pregnancy test confirmed she was not pregnant. Her doctor noted that her weight and mood had not changed, and there was no other clear reason for her missed period.

Since escitalopram was the only new medication, her doctor advised her to stop taking it. Within two weeks of discontinuation, her menstrual cycle returned to normal.

The opposite effect happened to a 21-year-old woman who was diagnosed with major depressive disorder. She started escitalopram 5 mg daily, which was increased to 10 mg after four days.

By the sixth day of treatment, she began experiencing unexpected vaginal spotting between her periods. She had no prior history of menstrual irregularities or bleeding between cycles.

The bleeding stopped quickly after the medication was stopped, and reappeared when it was restarted, indicating a likely link to the drug.

4. Weight and appetite changes

In short-term studies, Lexapro caused little to no average change in weight, but everyone’s body reacts differently.

A large analysis of over 183,000 adults across eight US health systems looked at eight commonly used antidepressants, including Lexapro. Overall, the average weight change was small across all of them. However, people taking Lexapro, Paxil (paroxetine), or Cymbalta (duloxetine) were about 10-15% more likely to gain at least 5% of their starting weight compared to those on other antidepressants.

In another short-term study, people taking Lexapro had almost no weight change, gaining only about 0.14 kg (roughly 0.3 lbs) after 12 weeks.

One longer study followed participants for eight months and compared Lexapro, Cymbalta, and a placebo. By the end:

    • those on Cymbalta gained about 0.61 kg (around 1.3 lbs)
    • those on Lexapro gained about 1.83 kg (around 4 lbs)

While Lexapro users gained a little more weight on average, the number of people who gained a noticeable amount of weight, defined by the FDA as 7% or more of their starting weight, was about the same for both medications. Still, both drugs caused more significant weight gain than the placebo.

5. Postpartum hemorrhage

Postpartum hemorrhage (PPH) or heavy bleeding after childbirth is one of the biggest concerns during delivery.

Some studies have hinted that taking certain mental health medications during pregnancy, like antidepressants or anti-anxiety drugs, might raise this risk, but research findings have been mixed.

A recent review of more than 107,000 births across seven hospitals in New York (2019-2022) found that women who took SSRIs such as escitalopram (Lexapro) or benzodiazepines had a higher risk of significant postpartum bleeding.

Another large analysis found that SSRIs were associated with about a 1.47-times higher risk of PPH compared to women who weren’t taking antidepressants.

A separate study also found a dose-related effect, which means the higher the SSRI dose, the greater the risk of bleeding and anemia after delivery.

In that research, postpartum hemorrhage (defined as blood loss of 1,000 mL or more) occurred in:

    • 8.4% of women not taking SSRIs
    • 14.6% of those on a moderate dose
    • 23.9% of those on a high dose

Average blood loss also increased slightly with SSRI use:

    • 406 mL in non-users
    • 483 mL in moderate-dose users
    • 482 mL in high-dose users

When to Call Your Doctor

Contact your doctor or seek urgent medical help if you notice any of the following:

  • New or worsening suicidal thoughts, severe restlessness, or sudden changes in behavior. These can sometimes occur early in treatment or after a dose change.
  • Possible signs of serotonin syndrome, such as high fever, confusion, stiff muscles, tremors, heavy sweating, or severe diarrhea, especially soon after increasing your dose or adding another medication that affects serotonin.
  • Fainting, a racing or irregular heartbeat, or severe dizziness. These could indicate a heart rhythm problem and should be evaluated right away.
  • Black or tarry stools, vomiting blood, or unusually heavy vaginal bleeding. These may be signs of internal or gastrointestinal bleeding that needs immediate care.
  • Sudden confusion, severe headaches, seizures, or unexpected falls. These may happen if your sodium levels drop too low. Ask your doctor whether testing is appropriate.
  • Painful breast swelling, milky nipple discharge (not related to breastfeeding), or missed periods when pregnancy is unlikely. Though rare, these changes should be checked to rule out hormonal side effects.

Never stop taking Lexapro suddenly, since doing so can cause withdrawal symptoms or make your condition return.

Summary

Lexapro helps improve mood and anxiety by keeping more serotonin active in the brain. Most people tolerate it well, with mild side effects like nausea, tiredness, or changes in sleep and sex drive that often improve over time.

In women, rare issues like breast changes, menstrual irregularities, or high prolactin levels have been reported. Weight gain can happen with long-term use, and using SSRIs during pregnancy may slightly increase the risk of postpartum bleeding.

Lexapro is generally safe and effective when taken as prescribed. Always follow your doctor’s instructions, avoid stopping the medication suddenly, and seek medical help if you notice severe or sudden side effects.

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Frequently Asked Questions

Yes, tremors from Lexapro often improve as your body adjusts to the medication. This side effect is more common in the first few weeks of treatment and usually fades with time. If the shaking continues or worsens, your doctor may adjust your dose or suggest a different antidepressant.

Some people may experience headaches or migraines when starting Lexapro, especially during the first few weeks. Staying hydrated, resting well, and taking your medication at the same time daily can help reduce symptoms. Let your doctor know if migraines become frequent or severe.

Avoid drinking alcohol excessively, since it can worsen drowsiness or mood symptoms. Refrain from taking other medications that increase serotonin (like St. John’s wort or certain migraine drugs) unless approved by your doctor. Also, avoid stopping Lexapro suddenly, since doing so can lead to withdrawal symptoms such as dizziness or irritability.

Lexapro may be used during pregnancy if the benefits outweigh the risks, but it’s best to discuss this carefully with your doctor. Lexapro’s label states that taking SSRIs, especially in the later part of pregnancy, may slightly raise the risk of breathing problems and other short-term adjustment issues in newborns, such as trouble feeding, low muscle tone, shaking, irritability, or unstable body temperature.

Human fertility data are mixed. One study found that women using SSRIs like Lexapro may have more difficulty becoming pregnant. Talk with your healthcare provider if you’re trying to conceive while on Lexapro.

There isn’t enough research yet. In one small study, eight breastfeeding mothers taking 10-20 mg of Lexapro each day passed very small amounts of the drug to their babies through breast milk, about 3.9% of the mother’s adjusted dose of Lexapro and 1.7% of its breakdown product. If your doctor advises you to keep taking Lexapro while breastfeeding, keep an eye on your baby for signs like unusual sleepiness, restlessness, irritability, poor feeding, or slow weight gain. If you notice any of these, let your doctor know right away.

Most mild side effects, like nausea, fatigue, or dizziness, ease within 1 to 3 weeks as your body adapts. Others, such as weight changes or reduced libido, may take longer or persist in some people. Always let your doctor know if side effects don’t improve over time.

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