Side Effects of Lexapro: The First Two Weeks and the Longer Term

Escitalopram (brand name Lexapro) is a commonly prescribed SSRI (selective serotonin reuptake inhibitor) used to treat depression and anxiety. Like all medications, it can cause side effects. Knowing what to expect during the first two weeks and beyond can help you feel more in control. If you ever have severe or worrying symptoms, speak to a doctor right away.

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What to Expect in the First Two Weeks

When you start Lexapro, your body is adjusting to higher serotonin levels in the brain. Most side effects during this period are mild to moderate and often improve after 1–2 weeks.

Common Early Side Effects

• Nausea
  Often the most reported complaint. Eating small, bland meals and taking Lexapro with food may help.
• Headache
  Over-the-counter pain relievers and staying hydrated can ease the discomfort.
• Drowsiness or Fatigue
  You may feel more tired than usual. Avoid driving or operating heavy machinery until you know how you react.
• Insomnia or Sleep Disturbance
  Some people have trouble falling asleep or staying asleep. A consistent bedtime routine may help.
• Increased Anxiety
  It may feel like anxiety spikes before it improves. This typically lessens after the first week or two.
• Dizziness
  Rise slowly from sitting or lying positions to reduce lightheadedness.
• Appetite Changes
  You might feel hungrier or less hungry. Keep balanced meals and watch your weight.
• Sweating
  Mild sweating is common and often fades with time.
• Dry Mouth
  Sipping water, chewing sugar-free gum, or using saliva substitutes can bring relief.

Tips for the First Two Weeks

• Take Lexapro at the same time each day to keep levels steady.
• Swallow tablets whole—don’t crush or chew.
• Keep a simple side-effect diary: note what you feel and when. This helps your doctor fine-tune your dose.
• If a side effect feels unbearable, speak to your doctor. They may adjust your dose or suggest coping strategies.

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Longer-Term Side Effects (After 4–6 Weeks and Beyond)

By month two or three, many early side effects have decreased. However, some can persist or emerge later.

Sexual Dysfunction

• Decreased Libido
• Delayed Orgasm or Anorgasmia
• Erectile Dysfunction (in men)
  Sexual side effects are among the most persistent. If these interfere with your quality of life, talk to your doctor. They may suggest dosage changes, “drug holidays,” or additional treatments.

Weight Changes

• Weight Gain
  Slower metabolism and increased appetite can contribute. A balanced diet and regular exercise are key.
• Weight Loss
  Less common but can occur, particularly if nausea persists.

Emotional Blunting or “Flattening”

• Feeling emotionally numb or less able to experience strong emotions.
  This can improve over time, but if it continues, discuss alternatives with your doctor.

Sleep Disturbances

• Insomnia or excessive sleepiness can persist in some people.
  Good sleep hygiene—or sometimes switching the time of dosing (morning vs. evening)—may help.

Withdrawal (Discontinuation) Symptoms

Stopping Lexapro abruptly can lead to:

• Dizziness or “brain zaps” (a sudden electrical-shock sensation)
• Irritability
• Flu-like symptoms (fatigue, headache, muscle aches)

To avoid withdrawal, your doctor will often taper your dose gradually.

Other Potential Long-Term Effects

• Bleeding Risk
  SSRIs may increase bleeding, especially if you take blood thinners or NSAIDs.
• Hyponatremia (low sodium)
  More common in older adults; watch for confusion, headaches, or weakness.
• Bone Density Changes
  Some research suggests a slight risk of decreased bone density with long-term SSRI use.

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When to Seek Immediate Help

While most side effects are manageable, seek medical attention right away if you experience:

• Chest pain or rapid heartbeat
• Severe dizziness or fainting
• Signs of an allergic reaction (rash, itching, swelling, difficulty breathing)
• Suicidal thoughts or worsening depression/anxiety
• Seizures

For any troubling symptoms, consider a free, online symptom check, using the doctor approved Ubie Symptom Checker. Always follow up with your healthcare provider.

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Tips to Manage Side Effects

1. Take Lexapro at the same time every day, with or without food as directed.
2. Stay hydrated and maintain a balanced diet.
3. Keep active—regular exercise can improve mood, energy, and sleep.
4. Practice relaxation techniques (deep breathing, meditation, yoga).
5. Keep a side-effect journal to track what helps and what doesn’t.
6. Speak openly with your doctor about any persistent or new symptoms.

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Final Thoughts

Most people tolerate Lexapro well, and many side effects improve after the first two weeks. By staying informed, tracking your symptoms, and communicating with your doctor, you’ll get the most benefit from treatment while minimizing discomfort.

If you ever feel that a side effect is severe, life-threatening, or affecting your daily life, do not hesitate to speak to a doctor. Your health and safety come first.