Lexapro For Anxiety: What You Need To Know

Up to one in five adults¹ in the US suffer from an anxiety disorder. Generalized anxiety disorder is a particularly common condition that affects 3.1% of the US population.² 

Women are more likely than men to be affected by anxiety. One study³found that the chances of developing any type of anxiety disorder over a lifetime were 30.5% for women and 19.2% for men. 

A report⁴ by the World Health Organization (WHO) in 2017 found that anxiety disorders are  the sixth most common disorders causing significant disability in people’s lives in developed nations. 

If you struggle with anxiety, you may be prescribed Lexapro to help control your symptoms. Read on to discover what anxiety is, how Lexapro might help, how long it might take to work, and what risks and side effects you need to know. 

What is an anxiety disorder?

Experiencing anxiety when facing stressful situations from time to time is normal, but when your anxiety symptoms start to interfere with your daily life, you may have an anxiety disorder. If you have generalized anxiety disorder, you may experience some of the following symptoms:

• Frequently feeling nervous, irritable, or on edge

• Feeling a sense of impending doom or danger

• Physical symptoms including increased heart rate (heart palpitations), sweating abnormally, shaking or trembling, and breathing rapidly (hyperventilating)

• Difficulty concentrating or focusing

• Difficulty sleeping because you are feeling anxious

• Nausea, abdominal pain, or diarrhea

If you struggle with an anxiety disorder, you may find that you have excessive and persistent worry or fear about everyday situations (social anxiety disorder) or you may have repeated episodes of intense fear and anxiety (panic attacks). 

Panic attacks can be so severe that you can feel like you’re having a heart attack. You may find that you start adapting your lifestyle to avoid situations or activities that trigger your anxiety.

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), to be diagnosed with most anxiety disorders, your symptoms must have been present for at least six months, must result in significant distress or impairment in social and occupational areas, and must not be attributable to a physical cause, such as an overactive thyroid. 

Symptoms of an anxiety disorder often start in childhood or adolescence and continue into adulthood, but symptoms can also present in adulthood. 

Types of anxiety disorders

There are several types of anxiety disorders, including generalized anxiety disorder, social anxiety disorder, specific phobias or fears, and panic disorder (panic attacks). You may also experience anxiety as part of mixed anxiety and depressive disorder, in which case you may experience symptoms both of anxiety and depression.

Causes of anxiety disorders

The exact cause of anxiety is not fully known. It’s likely caused by a combination of genetic and environmental factors.

Genetics are known to play a role in the development of anxiety disorders. You are more likely to develop an anxiety disorder if you have a blood relative who suffers from an anxiety disorder.

Evidence suggests that an imbalance in your neurotransmitters¹ may also play a role in the development of anxiety disorders. People with low serotonin activity and elevated norepinephrine activity in the brain may be more prone to developing anxiety.  

The following factors have been identified as putting you at higher risk of developing an anxiety disorder:

• Trauma

• Stress as a result of ill health

• Excessive or persistent life stressors

• Personality type — as some personality types may be more prone to developing anxiety disorders

• Other mental health disorders such as depression or substance abuse

• Drug or alcohol use or misuse

Treatment of anxiety

The mainstay of treatment for anxiety disorders is medication in conjunction with psychotherapy, such as cognitive behavioral therapy (CBT). Lifestyle modifications, such as regular exercise and practicing mindfulness, can also be an effective part of your treatment regime.

Lexapro is a commonly prescribed medication for treating anxiety. Let’s take a deeper look at what Lexapro is and how it works.

What is Lexapro? 

The active ingredient in Lexapro is escitalopram, which is the generic name for the drug. Lexapro belongs to a class of drugs called selective serotonin reuptake inhibitors (SSRIs). 

How does it work? 

Since low serotonin activity is thought to be a contributing factor to the development of anxiety, SSRIs regulate serotonin levels in the brain.

SSRIs work by affecting the activity levels of neurotransmitters in the brain. Neurotransmitters are chemical messengers that relay messages between brain cells, or neurons. Serotonin is a neurotransmitter that affects well-being and happiness, thinking, memory, sleep, digestion, and circulation.

Normally, serotonin is released by neurons. Some of this serotonin attaches to other neurons, where it passes on its message. The serotonin that remains after the message is sent is reabsorbed by the neuron that initially released it. 

This process is called reuptake. Anxiety may be triggered there is an imbalance between the production and reuptake of serotonin. 

Lexapro works by preventing the reuptake of serotonin, which results in more serotonin being available to attach to other neurons. 

How long does Lexapro take to work?

SSRIs are considered first-line therapy⁵ for anxiety. Before starting treatment for anxiety, it is important to know that SSRIs can take anywhere from two to four (sometimes even up to six) weeks to start to take effect. Lexapro is no exception, so you should not expect to immediately feel better after starting treatment. In fact, you may even feel worse initially. 

When you start taking Lexapro, you may find that your anxiety symptoms get worse before getting better. You may experience increased jitteriness and an increase in your anxiety for the first two weeks on Lexapro treatment. 

Your doctor may prescribe another medication, such as a benzodiazepine, to take in conjunction with Lexapro for the first couple of weeks to help to counter this effect. Alternatively, your doctor may start you at a lower dose and gradually increase it to an effective dose over a few weeks. 

Side effects of Lexapro

As with any medication, Lexapro has some potential side effects which include:

• Agitation or restlessness

• Blurred vision

• Gastrointestinal symptoms, such as nausea or diarrhea

• Drowsiness

• Dry mouth

• Headache

• Frequent urination

• Increased or decreased appetite

• Weight gain or loss

• Sexual dysfunction

Many of the side effects of Lexapro are dose-dependent, so if you do experience side effects when taking Lexapro, talk to your doctor before giving up on the medication. Simply lowering your dose may allow your side effects to resolve. 

Most of the side effects of Lexapro also diminish with time⁶ as your body adjusts to the medication, so you may find that side effects that bothered you initially will resolve after four to eight weeks of treatment. Lowering your dose of Lexapro can help to alleviate side effects. 

Some less common, but more serious, side effects of Lexapro include:

• Serotonin syndrome

• Suicidal thoughts and/or behavior

• Abnormal bleeding

• Seizures

• Confusion

• Low blood sodium levels (more common in older adults)

If you experience any of these symptoms, you should see your doctor immediately. 

Serotonin syndrome, although rare, is a potentially life-threatening condition characterized by excessive sweating, shivering, incoordination, muscle spasms, and altered levels of consciousness. 

What dose of Lexapro is used for anxiety?

The typical dose⁷ of Lexapro for anxiety is 10mg daily. Your doctor may start you at 5mg and taper up to 10mg to prevent your anxiety symptoms from worsening during the first two weeks of treatment. 

When and how to stop taking Lexapro

Once the Lexapro has started working, your doctor will likely recommend that you stay on it for at least six to 12 months.⁸ When you do decide to stop taking your Lexapro, make sure to do so on your doctor’s advice to properly wean you off the medication. Sudden discontinuation of Lexapro treatment can lead to serotonin discontinuation syndrome. 

What is serotonin discontinuation syndrome? 

Serotonin discontinuation syndrome results from your body trying to readjust to no longer being under the influence of SSRI activity. Symptoms include dizziness, nausea, fatigue, drowsiness, headache, anxiety, and agitation. Usually, the symptoms start within about a week after stopping taking Lexapro and last for about three weeks. 

In order to avoid serotonin discontinuation syndrome, it's best to gradually taper your dose of Lexapro instead of suddenly stopping. Your doctor can advise you on the correct way to taper off your Lexapro use. 

How safe is it to take Lexapro?

Lexapro takes between two to six weeks to take effect and needs to be continued for at least six months to a year. Lexapro is generally considered safe for long-term use and is not addictive.⁶ 

While there are potential side effects of taking Lexapro, most resolve with time. Ensure that if you want to stop taking Lexapro, you do so under the guidance of your doctor to prevent serotonin discontinuation syndrome.

The lowdown

Anxiety is a common condition that affects up to one in five adults, and can severely affect your day-to-day functioning. If you are struggling with anxiety, speak to your doctor about whether medication may be right for you. 

Lexapro (containing the active ingredient escitalopram) is a safe and effective treatment that is commonly prescribed for anxiety. Lexapro is an SSRI, which regulates serotonin production and reuptake in the brain to improve your moods and overall mental wellbeing to reduce symptoms of anxiety.