Lexapro (escitalopram) is an antidepressant which works by increasing neurotransmitter activity in the brain. It is a selective serotonin reuptake inhibitor or SSRI-type medication which only affects one type of neurotransmitter, serotonin. It was designed to have fewer side effects, but it may also increase the risk of suicide in children and young adults and has been linked to a high risk of severe birth defects.
Lexapro Side Effects
Lexapro may also cause more severe side effects or complications which may be serious or life threatening including:
- Suicide – increased risk of suicide may occur when starting medication or changing doses, particularly in children, adolescents and young adults
- Birth Defects – increased risk of birth defects may include miscarriage, heart defects, persistent pulmonary hypertension of the neonatal (PPHN), and brain, skeletal or abdominal abnormalities such as anencephaly, craniosynostosis or omphalocele.
- Lexapro withdrawal – Long-term use of Lexapro may lead to physical dependence in some patients. If the medication is suddenly stopped, it may cause withdrawal symptoms known as “SSRI discontinuation syndrome”.
- Serotonin Syndrome an excess of serotonin in certain areas of the brain may cause symptoms including changes in mental function, blood pressure, heart rate, muscle symptoms, fever or severe nausea, vomiting and diarrhea, and in some cases may be fatal
Lexapro may cause common side effects such as nausea, sexual dysfunction, insomnia or anxiety, dizziness, sweating, dry mouth, weight changes, and constipation or diarrhea. Severe side effects should be reported to a medical professional and may require emergency treatment.
Lexapro, the brand name of the generic escitalopram, is a serotonin-specific or selective serotonin reuptake inhibitor (SSRI) antidepressant. SSRIs are a newer type of antidepressant, which was designed to be more effective and have fewer side effects than older medications. It is approved for major depression and generalized anxiety in adults and has been used for other psychiatric illnesses including bipolar disorder, obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD).
Neurotransmitters are chemicals, used by nerve cells to send messages to the next cell. There are a number of these chemical messengers in the brain, including norepinephrine, dopamine and serotonin. Depression may be caused by low neurotransmitter activity in the mood centers of the brain and increasing them can help relieve depression.
The first antidepressants worked by affecting both norepinephrine and serotonin but had debilitating side effects and were dangerous in certain conditions. SSRI medications, which only affect serotonin, were designed to be more effective with fewer side effects. Unfortunately, they have been found to cause a number of unexpected disorders, some of which may be fatal.
Lexapro’s manufacturer, Forest Laboratories was accused of improper marketing in 2009. The company paid $313 million in fines for promoting unapproved uses, hiding negative clinical research results, and paying kickbacks to doctors.
Lexapro and Suicide
Lexapro may increase the risk for suicide in patients who are depressed. Patients who are under 25 years of age, have bipolar disorder, or a history of suicidal thoughts, are at an even greater risk. In 2004, the FDA began requiring that a “black box warning” be added to prescribing information for Lexapro which requires that information about the risk of suicide must be printed with a black border at the top of prescribing information for Lexapro.
Lexapro and Birth Defects
Lexapro and certain other SSRIs were initially considered much safer for pregnant patients because they had no effect on norepinephrine. They were widely used in pregnancy until they were found to increase the risk of miscarriage and certain birth defects, some of which may be fatal.
Prescription medications are categorized by the U.S. Food and Drug Administration (FDA) as A through D and pregnancy category X.
- Category A medications have been tested in animals and pregnant women and have shown no adverse effects.
- Category B medications have not shown any risk in animal studies but there are no adequate studies done in pregnant women.
- Category C medications have shown birth defect risk in animals and there are no adequate studies in humans, but the potential benefits of the medication may outweigh potential risks.
- Category D medications have shown fetal injury in both animals and humans, but the potential benefits may still outweigh a significant risk.
- Category X medications are known to be highly teratogenic or will cause fetal harm to both animals and humans as shown in drug studies or adverse event reports. These risks clearly outweigh any potential benefits and should not be used in pregnant women.
Though it was originally approved as a Class B pregnancy category medication, in 2006, the FDA issued a warning about the risks of Lexapro-related birth defects and it is now classified as a Pregnancy Category C medication. Lexapro should not be used during pregnancy unless absolutely necessary.
Birth defects linked to Lexapro use include:
- Persistent Pulmonary Hypertension in Newborn (PPHN), fatal in 10% of infants
- Hypoplastic Left/Right Heart Syndrome (HLHS, HRHS),
- Anencephaly (born without part of brain, skull and scalp), usually fatal shortly after birth
- Spina Bifida (underdeveloped vertebra which leaves spinal cord exposed), requires surgery, 15% fatal by age 4
- Cleft Palate or Lip (missing portion of roof of mouth or upper front jaw), may require surgery
- Omphalocele (abdominal organs on outside of body), requires surgery, sometimes fatal
- Scoliosis (curved spine), may require surgery
- Club feet (feet curl inwards, may require surgery
- Autism Spectrum Disorder (ASD) or Delayed Development Disorder (DDD)
- Withdrawal symptoms or Serotonin Syndrome in infants
Lexapro and Serotonin Syndrome
Lexapro use may cause “serotonin syndrome” which occurs when too much serotonin builds up in the brain. It is more likely if it is taken other medications that also affect serotonin including treatments for migraine, cough suppressants, and certain herbal remedies.
Serotonin syndrome may include symptoms such as:
- Unusually high fever
- Increased heart rate and changes in rhythm
- Loss of balance or coordination
- Confusion and hallucinations
In some cases, serotonin syndrome may be life-threatening. All medications should be discussed with a physician to avoid drug interactions.
Long-term use of Lexapro may lead to physical dependence in some patients. If the medication is suddenly stopped, it may cause withdrawal symptoms known as “SSRI discontinuation syndrome”.
Some of these symptoms of serotonin withdrawal may last for a long time and may include:
- Chills and shivers
- Brain “zaps”
- Electrical type skin sensations
Tapering off of Lexapro, rather than simply stopping, may reduce the chance for severe withdrawal effects but some symptoms may last for a long period of time.
Side Effects of Lexapro
In addition to the serious risks of Lexapro, it also has a number of side effects which are related to serotonin.
Common side effects include:
- Diarrhea or constipation
- Weight changes
- Dizziness and drowsiness
- Fatigue and/or insomnia
- Dry mouth
- Sexual dysfunction (both males and females)
Forest Laboratories is facing a number of lawsuits for injuries caused by Lexapro use. Patients or loved ones of those injured by Lexapro may be eligible for compensation for lost wages, medical costs and pain and suffering.