Escitalopram has a relatively favorable side effect profile compared to other antidepressant medications. Some of the most common side effects in order of frequency are, headache, nausea, somnolence, insomnia, dry mouth, fatigue, decreased libido, constipation, and flu-like symptoms. There is also evidence that SSRIs are correlated with an increase in
suicidal ideation in certain individuals. An analysis conducted by the FDA found a statistically insignificant 1.5 to 2.4-fold (depending on the statistical technique used) increase of
suicidality among the adults treated with escitalopram for psychiatric indications. The authors of a related study note the general problem with statistical approaches: due to the rarity of suicidal events in clinical trials, it is hard to draw firm conclusions with a sample smaller than two million patients.
Citalopram and escitalopram are associated with a mild dose-dependent
QT interval prolongation, which is a measure of how rapidly the heart muscle repolarizes after each heartbeat. Prolongation of the QT interval is a risk factor for
torsades de pointes (TdP), a heart rhythm disturbance that is sometimes fatal. Despite the observed change in the QT interval, the risk of TdP from escitalopram appears to be quite low, and it is similar to other antidepressants that are not known to affect the QT interval. A 2013 review discusses several reasons to be optimistic about the safety of escitalopram. It references a crossover study in which 113 subjects were each given four different treatments in randomized order: placebo, 10 mg/day escitalopram, 30 mg/day escitalopram, or 400 mg/day
moxifloxacin (a
positive control known to cause QTc prolongation). At 10 mg/day, escitalopram increased the QTc interval by 4.5 milliseconds (ms). At 30 mg/day, the QTc increased by 10.7 ms. A QTc increase of less than 60 ms is not likely to confer significant risk. Of the 9 antidepressants that were used by patients with TdP, escitalopram ranked 7th by TdP incidence in elderly patients (only
venlafaxine and
amitriptyline had less risk), and it ranked 5th of 9 by TdP incidence in patients ages 18–64. Antidepressants as a class had a relatively low risk of TdP, and most patients on an antidepressant who experienced TdP were also taking another drug that prolonged QT interval. Specifically, 80% of the escitalopram users who experienced TdP were taking at least one other drug known to cause TdP. For comparison, the most popular
antiarrhythmic drug in the study was
sotalol with 52,750 users, and sotalol had a TdP incidence of 81.1 cases and 41.2 cases of TdP per 100,000 users in the ≥65 and 18-to-64-year-old demographics, respectively. The US Food and Drug Administration and Health Canada did not similarly order restrictions on escitalopram dosage, only on its predecessor
citalopram. Like other SSRIs, escitalopram has also been reported to cause
hyponatremia (low sodium levels), with rates ranging from 0.5 to 32%, which can often be attributed to
SIADH. This is typically not dose-dependent and at higher risk for occurrence within the first few weeks of starting treatment. Like other SSRIs, escitalopram often exacerbates symptoms of
mania and
hypomania in individuals misdiagnosed with a depressive disorder instead of a
bipolar disorder, making it crucial for clinicians to rule out bipolar disorders before prescribing escitalopram. •
Headache (24%) •
Nausea (18%) •
Ejaculation disorders (9–14%) •
Somnolence (4–13%) •
Insomnia (7–12%)
Common (1–10% incidence) Common effects (1–10% incidence) include: • Abnormal
dreams •
Anisocoria •
Anorgasmia •
Anxiety •
Arthralgia (joint pain) •
Constipation •
Decreased or
increased appetite •
Diarrhea •
Dilated pupils •
Dizziness •
Dry mouth •
Excessive sweating •
Fatigue •
Fever •
Impotence (erectile dysfunction) •
Libido changes •
Myalgia (muscular aches and pains) •
Paraesthesia (abnormal skin sensation) •
Restlessness •
Sinusitis (nasal congestion) •
Tremor •
Vomiting •
Yawning Psychomotor effects The most common effect is fatigue or somnolence, particularly in older adults, although patients with pre-existing daytime sleepiness and fatigue may experience paradoxical improvement of these symptoms. Escitalopram has not been shown to affect serial reaction time, logical reasoning, serial subtraction, multitasking, or
Mackworth Clock task performance.
Post-SSRI sexual dysfunction Post-SSRI sexual dysfunction (PSSD) is an
iatrogenic condition in which sexual side effects persist after discontinuation of serotonin reuptake inhibiting antidepressants, including escitalopram. Characteristic symptoms include genital numbness, pleasureless or weak orgasm, loss of libido, and
erectile dysfunction; non-sexual symptoms such as
emotional blunting and cognitive impairment may also occur. The
DSM-5 noted in 2013 that serotonin reuptake inhibitor-induced sexual dysfunction may persist after the agent is discontinued. A 2023 retrospective cohort study of over 12,000 males estimated the risk of irreversible sexual dysfunction at approximately 0.46% of patients treated with serotonergic antidepressants, including SSRIs, though the actual prevalence remains uncertain and the condition is likely underreported. A 2023 systematic review found that escitalopram was the single most frequently reported SSRI in PSSD case reports, followed by citalopram, paroxetine, sertraline, and fluoxetine. In 2019, the
European Medicines Agency's
Pharmacovigilance Risk Assessment Committee (PRAC) recommended that product labels for all SSRIs and SNRIs, including escitalopram, be updated to state that sexual dysfunction may be long-lasting even after treatment is stopped.
Health Canada followed with similar label updates in 2021.
Pregnancy Antidepressant exposure (including escitalopram) is associated with shorter duration of pregnancy (by three days), increased risk of preterm delivery (by 55%), lower birth weight (by 75 g), and lower
Apgar scores (by <0.4 points). Antidepressant exposure is not associated with an increased risk of spontaneous abortion. There is a tentative association of SSRI use during pregnancy with heart problems in the baby.
Withdrawal Escitalopram discontinuation, particularly abruptly, may cause certain
withdrawal symptoms such as "electric shock" sensations, colloquially called "brain shivers" or "
brain zaps" by those affected. Frequent symptoms in one study were
dizziness (44%), muscle tension (44%),
chills (44%), confusion or trouble concentrating (40%), amnesia (28%), and crying (28%). Very slow tapering is recommended. There have been spontaneous reports of discontinuation of escitalopram and other SSRIs and SNRIs, especially when abrupt, leading to dysphoric mood,
irritability, agitation, anxiety, headache,
lethargy,
emotional lability,
insomnia, and
hypomania. Other symptoms such as
panic attacks, hostility,
aggression,
impulsivity,
akathisia (psychomotor restlessness),
mania, worsening of depression, and suicidal ideation can emerge when the dose is adjusted down. ==Overdose==