Experiences with

Escitalopram

Escitalopram is a type of antidepressant known as a selective serotonin reuptake inhibitor (SSRI).

It's often used to treat depression and is sometimes used for anxiety, obsessive compulsive disorder (OCD) or panic attacks.

Escitalopram helps many people recover from depression and has fewer side effects than older antidepressants.

Escitalopram is available on prescription. It comes as tablets and liquid drops that you put in a drink.

Who can take escitalopram

Most adults aged 18 and over can take escitalopram.

If you have diabetes, escitalopram can make it more difficult to keep your blood sugar stable. Your doctor may recommend that you monitor your blood sugar more often for the first few weeks of treatment with escitalopram and adjust your diabetes treatment if necessary.

Who may not be able to take escitalopram

Escitalopram is not suitable for some people. To make sure it's safe for you, tell your doctor before taking escitalopram if you:

• have ever had an allergic reaction to escitalopram or any other medicine
• have epilepsy or are having electroconvulsive treatment – escitalopram may increase your risk of having a seizure
• have a heart problem – escitalopram can give you an irregular heartbeat or make your heart beat faster
• have ever been tested for low sodium levels
• are trying to become pregnant, already pregnant or breastfeeding
• have glaucoma – escitalopram can increase the pressure in your eye

Dosage and strength

Escitalopram tablets come in different strengths ranging from 5mg to 20mg.

The usual dose of escitalopram is 10mg a day. But your doctor may start you on a lower dose and increase it to a maximum dose of 20mg a day.

If you have liver problems, the maximum recommended dose is 10mg a day.

With liquid drops, 1 drop is equivalent to 1mg of escitalopram, 10 drops is 10mg, and 20 drops is 20mg.

How to take it

Take escitalopram once a day. You can take it with or without food.

You can take escitalopram at any time of day, as long as you stick to the same time every day.

If you have trouble sleeping, it's best to take it in the morning.

How long to take it for

Once you're feeling better it's likely that you'll keep taking escitalopram for several more months to prevent the symptoms returning.

The decision to stop your treatment or carry on will depend on what symptoms you have and how serious they are. It will also depend on whether it's a one-off problem or one that keeps coming back, how well escitalopram works for you, and whether you have had any bad side effects.

If you forget to take it

If you forget to take a dose and remember before you go to bed, take it straight away. Carry on as usual the next day.

If you only remember during the night or the next day, leave out the missed dose and carry on as usual.

Do not take a double dose to make up for forgotten doses.

If you forget doses often, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

Stopping escitalopram

If you have been feeling better for 6 months or more, your doctor may suggest coming off escitalopram.

Your doctor will probably recommend reducing your dose gradually over several weeks, or longer if you have been taking escitalopram for a long time.

This is to help prevent any withdrawal side effects you might get as a reaction to coming off the medicine. These can include:

• dizziness
• feeling sick
• numbness or tingling in the hands or feet
• trouble sleeping
• feeling agitated or anxious
• headaches
• shaking

Do not stop taking escitalopram suddenly or without talking to your doctor first.

The amount of escitalopram that can lead to an overdose varies from person to person.

• you take more than your prescribed dose of escitalopram

Go to 111.nhs.uk or call 111

• you or someone around you has a seizure or fit

Find your nearest A&E

If you need to go to A&E, do not drive. Ask someone to drive you or call 999 and ask for an ambulance.

Bring the escitalopram packet or leaflet inside it, any remaining medicine, and any other medicines you take.

Common side effects

Common side effects of escitalopram happen in more than 1 in 100 people. There are things you can do to help cope with them:

Speak to a doctor or pharmacist if the advice on how to cope does not help and any of these side effects bother you or last more than a few days.

Serious side effects

Book an appointment with your doctor if:

• you lose or gain weight without trying
• you get changes in your periods, such as heavy bleeding, spotting or bleeding between periods

Call your doctor or call 111 now if:

• you have constant headaches, long-lasting confusion or weakness, or frequent muscle cramps – these can all be signs of low sodium levels in your blood
• you have a high temperature, feel agitated or confused, or you're trembling and twitching – this could be a sign of serotonin syndrome
• you start coughing up blood or have blood in your pee
• you have black or red poo or blood in your vomit – these can be signs of bleeding from the gut
• you are bleeding from the gums, or have bruises that appear without a reason or get bigger

• you get painful erections that last longer than 2 hours – this may happen even when you're not having sex
• you have severe dizziness or pass out
• you get any bleeding that's severe or you cannot stop, such as cuts or nosebleeds that do not stop within 10 minutes
• you have thoughts about harming yourself or ending your life

Find your nearest A&E

In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to escitalopram.

The good effects of escitalopram may, after a while, improve your sex life as your mood lifts and you become interested in life and relationships again.

Some of the possible sexual side effects include:

• painful erections and problems getting an erection and ejaculating
• vaginal bleeding and not reaching orgasm the same way as before
• a lower sex drive

Sexual side effects usually pass after the first couple of weeks. However, very rarely, they can be long lasting and may not get better even after stopping the medicine.

If these happen and are a problem for you, go back to your doctor to see if there's another treatment you can try.

Other side effects

These are not all the side effects of escitalopram. For a full list, see the leaflet inside your medicine packet.

Escitalopram and pregnancy

Escitalopram can be taken during pregnancy. A few studies have suggested that escitalopram might occasionally affect the development of a baby's heart. However, if there is any risk, it is small, and the majority of babies born to women taking escitalopram will have a normal heart.

When escitalopram is taken in the weeks before delivery it can sometimes cause short-term withdrawal symptoms and, very rarely, breathing problems in babies. Your baby will be checked after they're born and given extra care if they need it.

Taking escitalopram in the last month of pregnancy may slightly increase your risk of bleeding after delivery. However, this side effect is rare and treatable so it's not a reason to stop taking escitalopram.

It's important that depression and anxiety are well treated during pregnancy as these can affect both you and your baby's wellbeing. Depression and anxiety can sometimes get worse during pregnancy, and after your baby is born.

Speak to your doctor if you become pregnant. They will help you weigh up the risks and benefits so you can decide on the best treatment for you and your baby.

Escitalopram and breastfeeding

If your doctor or health visitor says your baby is healthy, you can take escitalopram while breastfeeding.

Escitalopram passes into breast milk in small amounts. It does not usually cause any problems but it has been linked with side effects including being unusually irritable or restless and being sick in a few breastfed babies.

Talk to your health visitor, midwife, pharmacist or doctor as soon as possible if:

• your baby is unusually irritable or restless
• your baby is unusually sleepy
• your baby is not feeding as well as usual
• you have any other concerns about your baby

It's important to continue taking escitalopram to keep you well. Breastfeeding will also benefit both you and your baby.

Although other medicines might be preferred while you are breastfeeding, it's important you take the medicine that works for you. If you are breastfeeding, or planning to breastfeed, talk to your doctor or pharmacist to help you decide what is best for you.

Escitalopram and fertility

Escitalopram may possibly reduce sperm quality, but it's not known whether this reduces fertility or not. Speak to your doctor if you're having difficulty conceiving a baby.

For women, there's no evidence to suggest that taking escitalopram will reduce your fertility.

Speak to a pharmacist or your doctor if you're trying to get pregnant as they may want to review your treatment.

Cautions with other medicines

Some medicines and escitalopram can affect each other and increase the chances of you having side effects.

Tell your pharmacist or doctor if you're taking any of these medicines before you start escitalopram:

• any medicines that affect your heartbeat – escitalopram can give you an irregular heartbeat or make your heart beat faster
• any other medicines for depression – some rarely used antidepressants can affect escitalopram to cause very high blood pressure even when they have been stopped for a few weeks

These are not all the medicines that can affect escitalopram. For a full list, see the leaflet inside your medicine packet or check with your pharmacist.

Mixing escitalopram with herbal remedies and supplements

Do not take St John's wort, the herbal remedy for depression, while you're being treated with escitalopram as this will increase your risk of side effects.

There's not enough information to say that other herbal remedies and complementary medicines are safe to take with escitalopram. They're not tested in the same way as pharmacy and prescription medicines. They're generally not tested for the effect they have on other medicines.

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