Anxiety disorder

Escitalopram appears to be effective in treating general anxiety disorder, with relapse on escitalopram at 20% rather than placebo at 50%.[20]

Escitalopram appears effective in treating social anxiety disorder.[21]

Other[edit]

Escitalopram, as well as other SSRIs, is effective in reducing the symptoms of premenstrual syndrome, whether taken in the luteal phase only or continuously.[22] There are no good data available for escitalopram as treatment for seasonal affective disorder as of 2011.[23] SSRIs do not appear to be useful for preventing tension headaches or migraines.[24][25]

Side effects[edit]

Escitalopram, like other SSRIs, has been shown to affect sexual functions causing side effects such as decreased libidodelayed ejaculation, and anorgasmia.[26][27]

An analysis conducted by the FDA found a statistically insignificant 1.5 to 2.4-fold (depending on the statistical technique used) increase of suicidality among the adults treated with escitalopram for psychiatric indications.[28][29][30] The authors of a related study note the general problem with statistical approaches: due to the rarity of suicidal events in clinical trials, it is hard to draw firm conclusions with a sample smaller than two million patients.[31]

Escitalopram is not associated with weight gain. For example, 0.6 kg mean weight change after 6 months of treatment with escitalopram for depression was insignificant and similar to that with placebo (0.2 kg).[32]

Citalopram and escitalopram are associated with dose-dependent QT interval prolongation[33] and should not be used in those with congenital long QT syndrome or known pre-existing QT interval prolongation, or in combination with other medicines that prolong the QT interval. ECG measurements should be considered for patients with cardiac disease, and electrolyte disturbances should be corrected before starting treatment. In December 2011, the UK implemented new restrictions on the maximum daily doses at 20 mg for adults and 10 mg for those older than 65 years or with liver impairment.[34][35] There are concerns of higher rates of QT prolongation and torsades de pointes compared with other SSRIs.[36][37] The U.S. Food and Drug Administration and Health Canada did not similarly order restrictions on escitalopram dosage, only on its predecessor citalopram.[38]

Discontinuation symptoms[edit]

Escitalopram discontinuation, particularly abruptly, may cause certain withdrawal symptoms such as “electric shock” sensations[39] (also known as “brain shivers” or “brain zaps”), dizziness, acute depressions and irritability, as well as heightened senses of akathisia.[40]

Sexual dysfunction[edit]

Some people experience persistent sexual side effects after they stop taking SSRIs.[41] This is known as post-SSRI sexual dysfunction (PSSD). Common symptoms include genital anesthesia, erectile dysfunction, anhedonia, decreased libido, premature ejaculation, vaginal lubrication issues, and nipple insensitivity in women. Rates are unknown, and there is no established treatment.[42]

Pregnancy[edit]

Antidepressant exposure (including escitalopram) is associated with shorter duration of pregnancy (by three days), increased risk of preterm delivery (by 55%), lower birth weight (by 75 g), and lower Apgar scores (by <0.4 points). Antidepressant exposure is not associated with an increased risk of spontaneous abortion.[43] There is a tentative association of SSRI use during pregnancy with heart problems in the baby.[44] The advantages of their use during pregnancy may thus outweigh the possible negative effects on the baby.[44]

Overdose[edit]

Excessive doses of escitalopram usually cause relatively minor untoward effects, such as agitation and tachycardia. However, dyskinesiahypertonia, and clonus may occur in some cases. Therapeutic blood levels of escitalopram are usually in the range of 20–80 μg/L but may reach 80–200 μg/L in the elderly, patients with hepatic dysfunction, those who are poor CYP2C19 metabolizers or following acute overdose. Monitoring of the drug in plasma or serum is generally accomplished using chromatographic methods. Chiral techniques are available to distinguish escitalopram from its racemate, citalopram.[45][46][47] Escitalopram seems to be less dangerous than citalopram in overdose and comparable to other SSRIs.[48]