Escitalopram side effects
Pro Research Analysisby 
Searched over 200M research papers
Consensus Meter
Side Effects of Escitalopram: A Comprehensive Overview
Common Side Effects of Escitalopram
Gastrointestinal Issues
One of the most frequently reported side effects of escitalopram is gastrointestinal discomfort. Patients often experience nausea, vomiting, diarrhea, and dry mouth . These side effects are common across many antidepressants, but escitalopram and sertraline are particularly noted for their gastrointestinal impact. Despite these side effects, they are generally mild and transient, often resolving within the first few weeks of treatment.
Nausea and MicroRNA Associations
Nausea is a prevalent side effect, affecting approximately 42.5% of patients treated with escitalopram. Research has identified changes in microRNA (miRNA) expression associated with the onset of nausea. Specifically, the overexpression of miR185-5p has been linked to a decrease in the intensity of nausea, suggesting a potential molecular mechanism behind this side effect.
Less Common Side Effects
Mydriasis
Mydriasis, or pupil dilation, is a less common but notable side effect of escitalopram. A case study reported a patient experiencing blurry vision and photophobia due to mydriasis after increasing the escitalopram dose to 20 mg/day. This side effect resolved upon discontinuation of the medication. Clinicians should be aware of this potential side effect and educate patients accordingly.
Sexual Dysfunction
Sexual side effects, including ejaculatory problems, are also associated with escitalopram use. These issues are generally mild but can be persistent, affecting patient adherence to the medication.
Cardiovascular Safety
Cardiovascular Adverse Reactions
In patients with preexisting cardiovascular conditions, escitalopram does not significantly increase the risk of major adverse cardiovascular events (MACE), QTc prolongation, or medication discontinuation compared to placebo. This makes escitalopram a relatively safe option for patients with underlying cardiovascular diseases, although further studies are needed to confirm these findings due to the limited number of studies and wide confidence intervals.
Genetic Factors Influencing Side Effects
CYP2C19 Polymorphisms
Genetic polymorphisms, particularly in the CYP2C19 enzyme, play a significant role in the metabolism of escitalopram. Poor metabolizers (PMs) of CYP2C19 have been found to experience higher rates of gastrointestinal and central nervous system side effects, as well as sexual dysfunction, compared to extensive metabolizers (EMs). These findings suggest that genetic testing could be beneficial in tailoring antidepressant therapy to minimize side effects and improve efficacy.
Conclusion
Escitalopram, while effective in treating major depressive disorder, is associated with a range of side effects, primarily gastrointestinal issues, nausea, and sexual dysfunction. Less common side effects like mydriasis and cardiovascular reactions should also be considered. Genetic factors, particularly CYP2C19 polymorphisms, can influence the severity and frequency of these side effects. Understanding these side effects and their underlying mechanisms can help clinicians make more informed decisions and improve patient adherence to treatment.
Sources and full results
Most relevant research papers on this topic