Side effects of escitalopram
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Side Effects of Escitalopram: A Comprehensive Overview
Common Side Effects of Escitalopram
Escitalopram, a selective serotonin reuptake inhibitor (SSRI), is widely used to treat major depressive disorder (MDD) and generalized anxiety disorder (GAD). Common side effects associated with escitalopram include nausea, headache, insomnia, and ejaculatory problems. These side effects are generally mild and transient, often resolving within a few weeks of treatment initiation 34. Nausea, in particular, was reported by 42.5% of patients in one study, highlighting its prevalence among escitalopram users 2.
Rare and Severe Side Effects
While most side effects of escitalopram are mild, there are rare but severe side effects that clinicians should be aware of. These include acute dyskinesia and extrapyramidal disorders, which have been reported in pediatric cases following escitalopram ingestion 4. Additionally, mydriasis, or pupil dilation, has been documented as a side effect, particularly after dose adjustments 5. These severe side effects necessitate careful monitoring, especially in vulnerable populations such as children and adolescents.
Cardiovascular Safety
The cardiovascular safety of escitalopram has been a subject of concern, particularly in patients with preexisting cardiovascular conditions. However, a systematic review and meta-analysis found that escitalopram does not significantly increase the risk of major adverse cardiovascular events (MACE), QTc prolongation, or medication discontinuation compared to placebo 6. This suggests that escitalopram is relatively safe for use in patients with underlying cardiovascular diseases, although further studies are needed to confirm these findings.
Impact of Side Effects on Treatment Adherence
Experiencing side effects during the initial weeks of treatment can impact patient adherence. Interestingly, one study found that patients who experienced any side effect during the first two weeks of treatment were more likely to complete the trial, suggesting that early side effects might not deter patients from continuing their medication 1. However, intolerable side effects that required dose reduction were less likely to resolve quickly, indicating the need for careful dose management 1.
Molecular Insights into Side Effects
Recent research has explored the molecular mechanisms underlying escitalopram's side effects. Changes in microRNA (miRNA) expression have been linked to the intensity of nausea experienced by patients. Specifically, the overexpression of miR185-5p was negatively associated with nausea severity, suggesting a potential molecular target for mitigating this common side effect 2.
Conclusion
Escitalopram is generally well-tolerated, with common side effects such as nausea and headache being mild and transient. However, rare but severe side effects like acute dyskinesia and mydriasis require careful monitoring. The drug appears to be safe for patients with cardiovascular conditions, although more research is needed. Understanding the molecular basis of side effects could lead to better management strategies, ultimately improving patient adherence and treatment outcomes.
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Most relevant research papers on this topic
Temporal Profiles and Dose-Responsiveness of Side Effects with Escitalopram and Duloxetine in Treatment-Naïve Depressed Adults
Escitalopram and duloxetine have similar side effect profiles at the doses used in this study, with dry mouth in duloxetine-treated patients being more likely to achieve remission.
RCT
Rigorous JournalAssociation Between Side Effects and Blood microRNA Expression Levels and Their Targeted Pathways in Patients With Major Depressive Disorder Treated by a Selective Serotonin Reuptake Inhibitor, Escitalopram: A CAN-BIND-1 Report
Overexpression of miR185-5p during escitalopram treatment for major depressive disorder is negatively associated with nausea intensity, potentially affecting CAMK2 expression.
Observational StudyRigorous JournalEscitalopram
Escitalopram effectively treats major depressive disorder at half the dosage of RS-citalopram, with rapid symptom improvement and predictable tolerability.
RCT
Highly CitedAcute dyskinesia and extrapyramidal disorder in a child after ingestion of escitalopram.
A 12-year-old boy developed acute dyskinesia and extrapyramidal disorder after ingestion of escitalopram, highlighting the need for caution in prescribing SSRIs to children.
Case ReportMydriasis caused by ESCITALOPRAM: A case report
Mydriasis is an uncommon side effect of SSRI antidepressants, and therapeutic patient education can help detect and treat abnormal side effects if necessary.
Case ReportCardiovascular adverse reactions associated with escitalopram in patients with underlying cardiovascular diseases: a systematic review and meta-analysis
Escitalopram does not significantly increase the risk of cardiovascular adverse reactions compared to placebo in patients with underlying cardiovascular disease.
Meta-AnalysisPretreatment anxious depression as a predictor of side effect frequency and severity in escitalopram and aripiprazole adjunctive therapy
Pretreatment anxious depression is associated with increased side effect frequency and severity in patients with major depressive disorder receiving escitalopram and aripiprazole adjunctive therapy.
Observational Study
Very Rigorous JournalSystematic review and meta-analysis on the therapeutic reference range for escitalopram: Blood concentrations, clinical effects and serotonin transporter occupancy
A target range of 20-40 ng/ml for escitalopram's antidepressant efficacy is recommended, with a lower concentration threshold supported by neuroimaging studies.
Meta-AnalysisImpact of acute administration of escitalopram on the processing of emotional and neutral images: a randomized crossover fMRI study of healthy women.
A single dose of escitalopram facilitates a positive information processing bias in healthy women, while attenuating negative emotion processing and decreasing negative appraisal.
RCTEscitalopram treatment for depressive disorder following acute coronary syndrome: a 24-week double-blind, placebo-controlled trial.
Escitalopram effectively reduces depressive symptoms and improves functioning in patients with depressive disorder following acute coronary syndrome, without reducing cardiovascular safety.
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