Selective serotonin reuptake inhibitors are the most widely used antidepressant drugs. In this article we will describe the therapeutic uses and side effects of escitalopram , a very popular SSRI that is especially effective in treating depression and various anxiety disorders because of its precise pharmacological activity.

What is escitalopram?

Escitalopram is an antidepressant drug in the class of selective serotonin reuptake inhibitors (SSRIs). Other widely used drugs in this group include sertraline, paroxetine, fluoxetine, fluvoxamine, and citalopram, a precursor to escitalopram that is very similar to it .

This psychotropic drug was created between 1997 and 2001 by the pharmaceutical companies H. Lundbeck A/S and Forest Laboratories, which had previous experience in the production of citalopram. It is now one of the most widely used SSRIs.

It is marketed under different names in many countries around the world. Some of the best known are Cipralex, Lexapro, Esertia, Meridian, Ipran and Heipram ; a large number of brands include the term “Escitalopram” in the product name.

Unlike other SSRIs, escitalopram exerts its effect highly selectively on serotonin receptors; this means that its interaction with receptors for other neurotransmitters is poor. Therefore, some authors attribute to it a greater efficacy than other SSRIs in the treatment of severe depression.

Selective serotonin reuptake inhibitors (SSRIs)

SSRIs are the most commonly prescribed group of antidepressants. Their effectiveness in treating symptoms of depression and anxiety is attributed to their agonism of different monoamines (a very relevant type of neurotransmitter): serotonin, noradrenaline and dopamine.

The exact mechanism of action of SSRIs is not known, although their effects are known to be associated with blocking the reuptake of serotonin, as the name suggests. These drugs increase the availability of serotonin in the synaptic space by limiting its reabsorption by post-synaptic receptors.

Medications in this class are primarily used to treat symptoms of depression, although many have also been shown to be effective in managing anxiety disorders, such as generalized anxiety disorder or obsessive-compulsive disorder. Fluoxetine is also prescribed in some cases of bulimia nervosa.

What is it used for?

Like other SSRIs, escitalopram has been shown to be effective in treating multiple symptoms related to anxiety and depression, although it is not approved for use in all countries for the same disorders.

Let’s see what are the most common therapeutic uses of escitalopram .

Major depressive disorder

Several scientific studies have demonstrated the effectiveness of escitalopram in the treatment of major depressive disorder. Some of the additional uses of this drug are associated with biologically related disorders of depression , in particular generalized anxiety disorder, obsessive-compulsive disorder and bulimia nervosa.

2. Generalized anxiety disorder

The therapeutic effects of escitalopram in cases of generalized anxiety disorder are significant and rapid; clear improvements are detected in the condition of most patients approximately two months after starting treatment.

3. Panic disorder

Panic disorder is characterized by the occurrence of panic attacks , during which symptoms such as tachycardia, breathing difficulties and fear of death arise. It may or may not be accompanied by agoraphobia.

4. Social phobia

In social phobia there appear symptoms of anxiety and avoidance associated with social interaction . In addition to antidepressants, sometimes anxiolytics are prescribed, particularly beta-blockers and benzodiazepines.

5. Obsessive-compulsive disorder

Escitalopram and some other SSRIs are also often used for the treatment of obsessive-compulsive disorder, or OCD, which is diagnosed when obsessive thoughts that cause anxiety are present and behavioral rituals are aimed at reducing discomfort.

Side effects of escitalopram

The most common side effects of escitalopram consumption are headache, nausea, diarrhea and insomnia . Others less common include the appearance of anxiety, dizziness, fatigue, drowsiness, sweating, dry mouth, constipation, burning and stomach gas.

It is also relatively common for sexual dysfunction to develop as a result of treatment with escitalopram and other SSRIs , especially decreased desire, genital anaesthesia, arousal disorders, delayed ejaculation and anorgasmia.

Serious adverse reactions to escitalopram, although rare, include seizures, breathing difficulties, heart rhythm disturbances and swelling of the face, hands and ankles.

Precautions and contraindications

Particular caution should be exercised when prescribing escitalopram if the person has relevant cardiac, respiratory, liver or kidney disorders , as well as if they have suffered manic episodes or epileptic seizures.

In children and adolescents, hostile behaviour and suicide attempts associated with escitalopram occur more frequently than has been detected in adults; however, in older people these reactions are also possible and are usually detectable by monitoring the effects of treatment during the first few weeks.

Given that there is a certain risk of pharmacological tolerance and dependence, abrupt discontinuation of consumption may lead to the appearance of the serotonergic syndrome characteristic of SSRIs. In this case the most common symptoms are the appearance of depressive reactions, irritability, feelings of dizziness and akathisia.

Its potential for negative interaction with other substances is low compared with that of other SSRIs, in particular paroxetine. Escitalopram and antidepressants of the monoamine oxidase inhibitor (MAOI) class should be avoided because of the increased risk of developing serotonin syndrome.

Bibliographic references:

  • General Council of Official Associations of Pharmacists. (2009). Mood disorders: depression and anxiety. Strategic plan for the development of pharmaceutical care’09.
  • Morán I, Baldirà J, Marruecos L, Nogué S. (2011). Clinical Toxicology. Madrid: Difusión Jurídica y Temas de Actualidad S.A.
  • Spanish Agency of Medicines and Health Products. Use of antidepressant drugs in Spain during the period (2015). 2000-2013. Drug use report [Internet] 2015 [Access: 2 August 2018] Available at: http://www.aemps.gob.es/medicamentosUsoHumano/observatorio/docs/antidepresivos2000-2013.pdf