12 Lexapro Side Effects to Know About — and How to Manage Them

Many prescription antidepressants are available to help you along your journey to better mental health. Lexapro (escitalopram) is one popular option. It’s FDA approved to treat depression and anxiety. It's part of a broader group of antidepressants called selective serotonin reuptake inhibitors (SSRIs).

If you’re prescribed Lexapro, there are possible side effects to keep in mind. Many are mild and manageable. But more serious Lexapro side effects should be addressed right away.

Lexapro side effects at a glance

Lexapro side effects are usually mild and improve after your body gets used to the medication. Some of the more common Lexapro side effects include:

• Nausea

• Headache

• Decreased sexual interest

• Erectile dysfunction

• Trouble ejaculating or having an orgasm

• Trouble sleeping or drowsiness

• Fatigue

• Dizziness

• Diarrhea or constipation

• Stomach pain

• Gassiness

• Dry mouth

• Appetite changes 

• Weight gain

• Feelings of anxiety

• Flu-like symptoms

• Sweating

More severe side effects are rare but possible:

• Abnormal bleeding

• Extremely elevated mood for several days in a row (mania or hypomania)

• Seizures

• Low sodium levels leading to confusion and weakness

• Muscle rigidity, hallucinations, or fever from a condition called serotonin syndrome

• Suicidal thoughts or behaviors

Below, we’ll take a closer look at 12 Lexapro side effects.

EXPERT PICKS: WHAT TO READ NEXT

• How to take Lexapro (escitalopram): Review pharmacist tips on how to take Lexapro to maximize its effects and reduce the impact of side effects.

• Managing interactions: Lexapro doesn’t always mix well with other medications and supplements. Learn more about common Lexapro interactions.

• Lexapro stories: People describe how Lexapro helps them manage their depression and anxiety — and what it feels like when they miss a dose.

1. Nausea

Nausea is one of the most common Lexapro side effects. In clinical anxiety studies, nearly 20% of people experienced it. Still, Lexapro may be less likely than other SSRIs to cause nausea. And any nausea you experience may improve over time as your body gets used to the medication.

If you’re experiencing nausea, try taking your Lexapro doses with food. This may help prevent stomach upset moving forward. It may also help to eat smaller, more frequent meals throughout the day (versus three large meals). Avoiding spicy, fried, or fatty foods can also help keep nausea at bay.

If these tips don’t work, you can try an OTC nausea medication like Bonine (meclizine). It’s best to get the OK from your prescriber or pharmacist first. If your nausea still doesn’t improve, talk to your prescriber again. They may recommend lowering your dosage or trying another antidepressant.

2. Headache

You may experience headaches after starting Lexapro. Headaches are one of the most commonly-reported side effects in people taking Lexapro for anxiety specifically. But keep in mind that headaches can also be a symptom of anxiety itself. So it's important to consider whether your headaches began after you started taking Lexapro or whether they were already happening.

Headaches from Lexapro may improve over time as your body adjusts to the medication. In the meantime, over-the-counter (OTC) pain relievers like Tylenol (acetaminophen) may help relieve headache pain. But be sure to talk to your prescriber first since these OTC medications aren’t safe for everyone to take.

3. Trouble sleeping

Some people taking Lexapro in clinical studies reported trouble sleeping (insomnia). This included trouble falling asleep and trouble staying asleep.

If you’re having a hard time sleeping while taking Lexapro, try taking your daily dose in the morning to see if that helps. It’s also a good idea to make sure you have a good sleep routine and sleep environment. This means going to bed and waking up around the same time every day, as well as having a dark, quiet room to sleep in. Being in direct sunlight in the morning and eating your last meal at least a few hours before bedtime can also help.

You might also try to do relaxing activities — like meditation, reading, or deep breathing — just before bed, to see if they help.

4. Drowsiness and dizziness

While Lexapro causes insomnia for some people, it can make other people feel drowsy.

If you find that Lexapro makes you sleepy, try taking your dose before bed. It can also help you feel more energized to add more nutrient-rich foods — such as fruits, vegetables, and whole grains — into your diet. Regular exercise can also boost your energy levels.

In addition to drowsiness, Lexapro can cause dizziness. Try to sit or lie down right away if you feel dizzy. It’s a good idea to avoid activities that require alertness, like driving, until you know how Lexapro affects you.

If drowsiness or dizziness don’t improve, let your healthcare professional know. Another treatment may be a better option for you.

5. Sexual problems

Sexual side effects are common with SSRIs. When taking Lexapro, you may experience:

• Decreased interest in having sex (low libido)

• Ejaculation problems

• Erectile dysfunction

• Trouble having an orgasm

There are ways to limit these side effects, however. For example, lowering your Lexapro dosage may improve sexual problems. But you shouldn’t attempt to do this on your own.

Depending on your situation, your healthcare professional may recommend switching to a different antidepressant. Wellbutrin XL (bupropion) and Remeron (mirtazapine) treat depression and typically have fewer sexual side effects than SSRIs. In fact, Wellbutrin XL is sometimes added to SSRIs to manage sexual side effects.

Good to know: Always talk to a healthcare professional before making any changes to your medication routine. Lowering your Lexapro dosage or stopping treatment without guidance may lead to withdrawal symptoms, such as stomach upset or pins and needles sensations. Lexapro withdrawal can also cause anxiety, restlessness, and irritation.

6. Diarrhea

Diarrhea is another relatively common Lexapro side effect. If you experience diarrhea after you start taking Lexapro, try sticking to a bland diet for a few days. It’s also a good idea to eliminate fried or greasy foods.

If your diarrhea doesn’t improve fairly quickly, your healthcare professional may recommend an OTC antidiarrheal medication. But if your symptoms continue for more than a few days, your prescriber may recommend other measures. Diarrhea that lasts a long time can lead to dehydration and be a sign that something more serious is going on.

7. Dry mouth

Lexapro is one of many antidepressants that can cause dry mouth. It's more likely to happen with a higher Lexapro dosage (20 mg a day) versus a lower dosage (10 mg a day).

Dry mouth isn’t usually dangerous, but it can be uncomfortable. If you’re experiencing dry mouth from Lexapro, some helpful management tips include drinking plenty of water, chewing sugarless gum, and avoiding tobacco and alcohol.

If these tips don’t help improve your symptoms, talk to your healthcare professional. They may suggest trying a saliva substitute like Biotene. Or they may recommend decreasing your Lexapro dosage or switching to another antidepressant.

8. Higher risk of bleeding

While rare, Lexapro may raise your risk of bleeding — especially stomach bleeds. Symptoms of a stomach bleed include dark stools or blood in your stool. Let your healthcare professional know immediately if you experience either of these symptoms or unusual bleeding or bruising.

The risk is higher if you combine Lexapro with other medications that also raise the risk of bleeding, such as:

• Nonsteroidal anti-inflammatory drugs (NSAIDs), like Advil or Aleve (naproxen) 

• Anticoagulants (blood thinners), like Coumadin (warfarin), Eliquis (apixaban), or Xarelto (rivaroxaban)

• Antiplatelet medications, like Plavix (clopidogrel) and Brilinta (ticagrelor)

• Other antidepressants, including serotonin and norepinephrine reuptake inhibitors (SNRIs) like Cymbalta (duloxetine)

Make sure your prescriber and pharmacist have a current list of your medications. They can identify any OTC and prescription medications that may raise the risk of bleeding when combined with Lexapro.

9. Activation of mania or hypomania

Lexapro may trigger a manic or hypomanic episode in people living with bipolar disorder. A manic episode is when a person feels extremely excited and energetic for at least 7 days (1 week). They may also engage in reckless behavior and have racing thoughts. A hypomanic episode is a milder version of this.

Before starting Lexapro, tell your healthcare professional if you have a personal or family history of bipolar disorder. They can determine whether it’s safe for you to take Lexapro.

10. Serotonin syndrome

Serotonin syndrome is a medical condition that can happen when there’s too much of the chemical serotonin in the brain. It’s a possible side effect of all SSRIs. And, in severe cases, it can be life-threatening.

Even though serotonin syndrome isn’t common with SSRIs, certain factors raise the risk. For example, serotonin syndrome is more likely to occur with higher Lexapro dosages. It’s also more likely if you take Lexapro with other medications or supplements that raise serotonin levels. This includes other antidepressants, such as monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants (TCAs), and SNRIs.

Possible symptoms of serotonin syndrome include:

• Sweating

• Fever

• Shivering

• Fast heartbeat

• Clumsiness or unsteadiness

• Agitation

More serious symptoms include seizures, confusion, and rigid muscles. If you experience any of these symptoms, let your healthcare professional know immediately and get emergency medical care.

11. Hyponatremia

Hyponatremia (low sodium levels) isn’t a common Lexapro side effect. It’s more likely to happen if you’re 65 or older or are taking a diuretic (water pill) like hydrochlorothiazide alongside Lexapro.

Your prescriber may perform a blood test to check your sodium levels if you’re experiencing symptoms such as:

• Nausea

• Fatigue

• Dizziness

• Muscle cramps

• Headache

If you experience serious symptoms such as vomiting, confusion, or seizures, it’s important to call 911 or seek emergency medical care right away. You may need treatment with IV fluids in a hospital setting to help correct your sodium levels.

12. Suicidal thoughts and behaviors

All antidepressants carry a boxed warning about the risk of suicidal thoughts and behaviors in people under 25 years old. This is the FDA’s most serious type of medication warning. Studies show that this age group has a greater chance of experiencing suicidal thoughts and behaviors when starting treatment with an antidepressant. 

Regardless of age, everyone taking Lexapro should watch for changes in their mood and behavior or worsening of symptoms. This is especially the case when starting treatment and with dosage changes. Reach out to your healthcare professional right away if this happens.

If you or someone you know is having thoughts of suicide, you’re not alone, and help is available. Call the National Suicide Prevention Lifeline at 988, or text HOME to 741-741 to reach the Crisis Text Line.

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Written by:

Jennifer Gershman, PharmD, CPh, PACS

Jennifer Gershman, PharmD, is a licensed pharmacist in Florida. She has worked in the pharmacy industry for more than 15 years and is currently a medical writer.

Edited by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

Reviewed by:

Stacia Woodcock, PharmD

Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.

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