Escitalopram
Lexapro
Selective Serotonin Reuptake InhibitorGeneric availableTDM data
The mechanism of antidepressant action of escitalopram, the S-enantiomer of racemic citalopram, is presumed to be linked to potentiation of serotonergic activity in the central nervous system (CNS) resulting from its inhibition of CNS neuronal reuptake of serotonin (5-HT).
Compare Escitalopram →FDA-Approved Indications
- Major depressive disorder — acute and maintenance (adults; adolescents 12–17 years)
- Generalized anxiety disorder — acute treatment (adults)
Common Off-Label Uses
- Panic disorder
- OCD
- PTSD
- PMDD
- Vasomotor symptoms (menopause)
What Sets This Drug Apart
- S-enantiomer of citalopram — at least 100-fold more potent than R-enantiomer at SERT; metabolites at least 7–27x less potent
- Minimal CYP inhibition profile among SSRIs: no inhibition of CYP3A4, 1A2, 2C9, 2C19, or 2E1; only modest CYP2D6 effect in vivo (desipramine AUC +100% at 20 mg/day)
- Lowest protein binding of any SSRI (~56%), reducing displacement interaction risk
- Linear, dose-proportional pharmacokinetics (unlike paroxetine and fluvoxamine)
- FDA-approved for adolescent MDD (ages 12–17) in addition to adult MDD and GAD
- Very clean receptor profile: no/very low affinity for all tested receptors and ion channels
- Cipriani 2018 MDD response OR 1.68 (95% CrI 1.50–1.87), acceptability OR 0.90 (0.80–1.02) — in both 'more effective' and 'more tolerable' groups
- Henssler 2024 any-symptom discontinuation rate 0.39 (95% CI 0.26–0.53, k=6) — highest point estimate among SSRIs
- Reichenpfader 2014 pairwise NMA: highest sexual-dysfunction signal among SSRIs (vs fluoxetine OR 0.37, escitalopram-higher)
- No dose-dependent QTc warning or mandated dose cap (unlike citalopram); thorough QT study shows 6.6 ms QTcF increase at 20 mg
Boxed Warning
SUICIDAL THOUGHTS AND BEHAVIORS