Escitalopram is a selective serotonin reuptake inhibitor (SSRI) used widely in Europe for depression and anxiety disorders. It is the S-enantiomer of citalopram and binds with high affinity to the serotonin transporter (SERT), increasing synaptic serotonin and gradually normalising mood, sleep, appetite, and cognitive symptoms of depression and anxiety. Compared with some SSRIs, escitalopram is pharmacologically “clean,” with low affinity for muscarinic, histaminergic, or adrenergic receptors; this contributes to a relatively favourable tolerability profile and low rates of sedation and anticholinergic effects.
Clinical evidence supports efficacy across major depressive disorder (MDD), generalised anxiety disorder (GAD), social anxiety disorder, panic disorder, and obsessive–compulsive disorder (OCD). Symptom improvement typically begins within 1–2 weeks, with full response over 4–8 weeks or longer. To prevent relapse, treatment is usually continued for at least 6–12 months after remission; some patients benefit from longer maintenance, particularly with recurrent illness.
Escitalopram is metabolised hepatically (CYP2C19, 2D6, 3A4) to weakly active metabolites and has a half-life of ~27–32 hours, allowing once-daily dosing. It has a comparatively modest effect on QT interval at licensed doses, but high doses or interacting medicines can increase risk. As with all antidepressants, monitoring for suicidality is critical during initiation and dose changes, particularly in people under 25.
Pair medication with psychotherapy and lifestyle supports (sleep hygiene, physical activity, social connection) to maximise recovery and resilience.
Most adverse effects emerge early and improve with continued treatment. If troublesome, dose timing, dietary measures, or titration adjustments often help.
Many side effects are manageable; discuss strategies rather than stopping abruptly. If sexual side effects persist and are unacceptable, consider dose adjustment or alternative therapy under clinician guidance.
Encourage patients to avoid alcohol excess, maintain sleep and activity routines, and report new/worsening anxiety, agitation, or suicidal thoughts promptly.
Escitalopram is metabolised by CYP2C19/2D6/3A4 and can interact with medicines that affect these enzymes or that also elevate serotonin or bleeding risk.
Always review over-the-counter medicines and herbals; St John’s wort commonly interacts.
Missed dose: take when remembered if the same day. If close to next dose, skip and continue the regular schedule. Do not double up.
Accidental double dose: usually mild (nausea, tremor, agitation). If unwell, contact a clinician or pharmacist.
Large overdose: symptoms may include somnolence, nausea/vomiting, tremor, tachycardia, hypotension, QT prolongation, seizures, or serotonin syndrome—seek urgent medical care. Hospital care is supportive: airway protection, ECG monitoring, IV fluids, benzodiazepines for agitation/seizures, management of QT abnormalities/electrolytes, and treatment of serotonin syndrome (cooling, benzodiazepines; cyproheptadine in severe cases).
Any intentional overdose requires psychosocial assessment once medically stable.
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