One in ten Americans are now taking antidepressant drugs like Lexapro. Antidepressants are an $11 billion annual business, and Lexapro’s sales alone have been over $2.5 billion a year. Lexapro is the fifth most popular Selective Serotonin Reuptake Inhibitor (SSRIs), a family of drugs that alters brain chemicals and includes Prozac, Zoloft, Celexa and Paxil.
Certain demographic groups are more likely to be taking antidepressants, particularly non-Hispanic whites. About 2.5 times as many women take them as men; in fact, among white women ages 40 to 50 years old, almost one in four is taking them.
The unprecedented number of people taking SSRIs has created an unusual problem. While the United States government classifies them as non-addictive drugs, between 10% and 20% of patients experience a “discontinuation syndrome” that includes symptoms of depression and anxiety. These patients and their doctors often assume their depression has rebounded as a result of not taking drugs. However, some people who are taking Lexapro or other SSRIs for conditions other than depression also will develop withdrawal symptoms that include depression when they stop taking these drugs, meaning that depression is not “rebound” but rather a symptom of discontinuation syndrome.
“Every year thousands try to pull off these drugs and doctors mistake discontinuation syndrome for rebound depression,” according to Dr. Joseph Glenmullen, author of Prozac Backlash.
As a result, millions are remaining on drugs like Lexapro for decades. One in three of these people has not seen a mental health professional in the past year, and many of them have never seen one. Some were diagnosed with depression during a routine 15-minute examination with their family physicians. While there is no doubt that antidepressants have helped many people and saved many lives, there is also no doubt they are over-prescribed and hard to discontinue.
What Is Lexapro?
Lexapro is the trademarked name of an SSRI called escitalopam.
When Forest Laboratories first introduced Lexapro, some experts did not consider it to be a new drug at all. Escitalopam is the (s)-stereoisomer of citalopam, an antidepressant that was already being sold under the trademarked name of Celexa by a global pharmaceutical company called Lundbeck. Scientists at Lundbeck split the Celexa molecule into two mirror image isomers or chemical compounds to use one isomer as the new drug. This dubious process of making new products from old drugs is called “Evergreening.” In 2002 the United States Food and Drug Administration approved Lexapro for the treatment of Major Depressive Disorders (MDD) and a year later for Generalized Anxiety Disorders. At $88 for a month’s supply, the drug is relatively expensive. It is now manufactured by both Lundbeck in Europe and Forest Laboratories in the United States.
Escitalopam comes as a fine white powder soluble in methanol and slightly soluble in water and methanol. The molecular formula is C20H21FN2O • C2H2O4 and the molecule looks like this:
Even though it can cause a withdrawal syndrome, the United States government does not classify Lexapro and other SSRIs as controlled, addictive substances.
Lexapro is sold as 10mg film-coated white oval pills with the letters E and L on one side, or as 20mg white oval pills with the letters E and N on one side. It also comes as a clear yellow solution. The usual dose is 10mg once a day with or without food but can be increased to 20mg if the patient does not respond within a week or so.
What Are the Medical Uses of Lexapro?
Lexapro is prescribed for Major Depressive Disorder (MDD), which psychiatrists define as having a depressed mood for more than two weeks, and having five of the following symptoms: loss of interest in everyday life, weight changes, appetite changes, sleep problems, motor agitation or retardation, tiredness, slow thinking, feeling guilty for no reason, and suicidal thoughts. MDD is not the same as ordinary depression resulting from normal crises such as job loss, bereavement, rejection, and other disappointments, and it can be difficult to diagnose. Unlike conditions such as diabetes or high blood pressure, doctors cannot at this time determine who has MDD based on physical examinations or laboratory results of blood and urine tests. They make their diagnoses by what their patients tell them.
As Dr. Jerrold Rosenbaum, a professor of psychiatry at Harvard Medical School, said, “Depressions have differences in symptoms, differences in their course, differences in age of onset, and differences in their relationship to an external precipitants, whether they be seasonal changes, menstrual cycles or stress.” All these affect how depression should be treated.
When SSRIs first were developed, scientists were working under the theory that depression was caused by an imbalance in brain chemicals. This may be true in patients who have MDD. SSRIs like Lexapro work by blocking proteins that transport serotonin out of nerve synapses (the spaces between the cells) in such a way that serotonin lingers in the brain. Serotonin is a neurotransmitter naturally released during moments of pleasure. However, research performed after the introduction of Lexapro and other SSRIs indicates that depression is a much more complex disease than formally thought, and that it is not just about serotonin shortages, as autopsies on depressed people have proven. The very latest analysis of the effect of Lexapro and other SSRIs indicate they are no more effective than placebos unless the person truly has MDD. In other words, if you just have a case of “the blues,” these drugs will not work for you.
Lexapro is also approved for generalized anxiety disorders, and prescribed off-label for social anxiety, panic disorders, obsessive-compulsive disorders, and other conditions.
What Are the Side Effects of Lexapro?
One of the most common and problematical side effects of Lexapro is that it can cause changes in the sex drive in some patients. Some stop experiencing orgasms and have decreases in sex drive, and men can either delayed ejaculation or the inability to achieve erections. Recent research indicates that these conditions can last for years even after you stop taking the drug.
Other common side effects are nausea, dizziness, constipation, sweating, heartburn, stomach pain, increase in appetite, shivering, wheezing, insomnia, joint pain, pain in the face, dry mouth, runny nose, flulike symptoms and a general feeling of illness.
The following side effects are rare and serious, and if you experience them, you should stop taking Lexapro and see your doctor. They include unusual excitement, hallucinations, convulsions, shortness of breath, fever, confusion, fast heartbeat, and severe muscle stiffness.
What Are the Risks of Taking Lexapro?
Two common problems associated with taking Lexapro are discontinuation syndrome and problems with sex discussed elsewhere in this article.
In March 2004, the U.S. Food and Drug Administration put a black box warning on Lexapro. Outside of pulling a drug off the market, this is the most severe move the agency can take. The black box warning says that in the early stages of treatment with Lexapro, patients under the age of 24 years old are more likely to have suicidal thoughts and to commit suicide than if they were not taking the drug. The warning was based on a study of 77,000 patients and 4,400 children taking SSRIs which found that 4% of the young people had an increase in suicidal thoughts, although none committed suicide. The risk for suicidal thoughts was especially high –35%– for those who had certain genetic markers. Most medical experts believe that the benefits of antidepressants outweigh their risks, because when young people stopped using the drug because of the black box warning, more of them committed suicide.
In a few rare cases, patients have life-threatening allergic reactions to Lexapro called anaphylaxis with symptoms such as shortness of breath, rashes, swelling, inability to breathe, and sometimes even coma.
Lexapro makes some people drowsy, and therefore compromises their ability to drive and increases their chances of falling.
Lexapro is associated with an increased risk for abnormal bleeding, and incidences of ecchymosis, bruising, nosebleeds, and hemorrhages. Lexapro increases the risk for hyponatremia, a life-threatening imbalance in electrolytes.
Who Should Not Take Lexapro?
The safety and effectiveness of Lexapro has not been established for patients under 12 years old.
Lexapro should not be taken by people with bipolar disorders or family histories of it, and those with diabetes, seizure disorders, restlessness, liver disease, bleeding problems, kidney or heart diseases.
Pregnant women who take Lexapro in their last trimesters increase their risk for giving birth to babies with Persistent Pulmonary Hypertension.
What Drugs Interact with Lexapro?
Lexapro should never be combined with monoamine oxidase inhibitors (MAOIs), because the combination can cause death. You need to wait two weeks after taking an MAOI such as Nardil, Parmate, Furoxone, Marplan, and Emsam before you take Lexapro.
Other serious reactions can occur if you combine Lexapro with medications for migraines, mental illnesses, ulcers, or malaria. Some medicines that should not be used with Lexapro are Pimizide, bupropion, tramadol, Zyvox, Relpax, Frova, Amerge, Maxalt, Imitrex, Zomig, Toprol, tricyclic antidepressants, fentanyl, lithium, ecstasy (MDMA), and St. John’s wort.
Most physicians advise patients not to combine Lexapro with alcohol or any drugs that cause drowsiness, including muscle relaxants, sleeping pills, tranquilizers, sedatives, narcotic pain killers, and medications for allergies, colds, and flu.
If you are taking drugs for bleeding disorders, drugs to prevent blood clots, or even over-the-counter drugs like aspirin and Aleve that affect bleeding, you should not use Lexapro.
What Lawsuits Involve Lexapro?
In 2009 the federal government filed a lawsuit accusing the manufacturer of Lexapro of fraud. While it is legal to prescribe Lexapro to children off-label, it is illegal to promote it as a children’s drug if the FDA has not approved it for pediatric use. Forest Labs allegedly hired over 2100 sales representatives to pass out samples of Lexapro to doctors, spent $35 million to lecture doctors about its benefits, and gave them kickbacks in the form of restaurant certificates, vacations, baseball tickets and so forth to encourage them to prescribe it. The company was also accused of suppressing research that showed the drug to be ineffective for children. The lawsuit alleged that “Forest Laboratories told doctors half-truths” and blurred the line between advertising and marketing until “there was no line.” In 2010 the company paid over $313 million to settle this case. It still faces lawsuits from pregnant women and others claiming it injured them.
What Is Lexapro Overdose?
Most people do not die from Lexapro overdoses. In one study, there were no fatalities even among those who took up to 600mg of it.
Symptoms of Lexapro overdoses can include dizziness, sweating, nausea, vomiting, tremors, drowsiness, fast heartbeat, seizures, confusion, forgetfulness, fast breathing, and in rare cases — coma. Standard emergency medical treatment is to open the person’s airways, “pump the stomach” or administer charcoal. Forcing urination or hemoperfusion usually is unhelpful. There are no antidotes for Lexapro.
What is more common and dangerous than Lexapro overdoses are drug reactions from combinations of Lexapro and alcohol or combinations of Lexapro and other drugs that affect serotonin levels in the brain. If you take Lexapro with other SSRIs or narcotic painkillers, the serotonin levels in your brain can become so high that you enter serotonin syndrome, which can be fatal.
Does Lexapro Show up in Routine Urine Tests?
Lexapro and other SSRIs typically do not show up on urine drug tests done at work or school because these tests are usually screening only for controlled substances and illegal drugs.
What Is Lexapro Discontinuation Syndrome?
Lexapro “discontinuation syndrome” is a series of symptoms that occur when you stopped taking the drug. About 20% of those taking SSRIs experience discontinuation syndromes, especially if they stop abruptly instead of tapering off their dosages with the help of physicians.
SSRIs have different half-lives in the body. Half-life refers to the amount of time it takes for the body to metabolize and completely eliminate the drug. Prozac has a long half-life of 5 to 6 weeks; Paxil is among the shortest and lasts only a few days. Lexapro is in the middle. The SSRIs with longer half-lives are harder to discontinue.
A discontinuation syndrome will start within days of stopping Lexapro, especially if you stop “cold turkey.” Dr. Michael Banov, author of Taking Antidepressants, says that his research indicates that 15% of those discontinuing Lexapro will have moderate symptoms, and 5% will have severe ones. The best thing to do to minimize your symptoms is to step down your dose in very small increments, even if this means that your withdrawal lasts for weeks. The riskiest period comes the end of withdrawal.
Symptoms are dizziness, pins and needles, vivid dreams, headaches, insomnia, vomiting, sweating, tremors, confusion, emotionality, irritability, diarrhea, fast or irregular heartbeat, agitation, sensory disturbances, blurred vision, ears ringing, flashing lights, crying spells, bladder control issues, sadness, and intense anxiety.
The most unusual symptom of Lexapro discontinuation syndrome is called “zaps” or “electric shocks.” These sensations can occur up and down the legs and arms as well as in the brain, and can be quite disturbing.
One study found that people with bipolar disorder who discontinued drugs like Lexapro were likely to experience manic episodes as well as the above symptoms.
The real problem Lexapro creates is that discontinuation syndrome can cause depression, even in those who are not taking it for depression. Doctors and their patients, often mistake depression caused by discontinuation syndrome with a return or rebound of major depressive disorder. In general, if depression returns quickly after you stop taking Lexapro, it is probably discontinuation syndrome. In any event, you should be thoughtfully monitored by a physician during withdrawal who can help you determine exactly what is going on with you.
How Can I Tell If I Am Abusing Lexapro?
If you’re considering whether you should stop taking Lexapro, ask yourself the following questions. If you can answer yes to several of them, you may want to consider asking your family physician or getting help through a local mental health clinic or addiction center for your problems with Lexapro.
- Do you experience withdrawal syndrome if you stop taking Lexapro or skip a dose?
- Have you tried to stop taking Lexapro and failed?
- Do you want to stop taking Lexapro but don’t know how?
- Do you believe you will have to take Lexapro for the rest of your life?
- Are you using Lexapro without a doctor’s prescription?
- Do you abuse illegal drugs or prescription drugs for non-medical reasons?
- Do you think that your life and your stress is so difficult that you need to take drugs?
- Have you tried using non-drug methods to deal with your depression or anxiety, such as psychotherapy and improving your health habits?
- Does Lexapro cause side effects that you find are difficult to manage?
- Do you think you might have needed Lexapro when you first started to take it, but that you might not need it now?
- Do you think you need professional help to stop taking Lexapro?
What Treatment or Help Is Available for Lexapro Withdrawal?
You should not try to withdraw from Lexapro on your own. You should ask your doctor to gradually taper off your dosage until you are completely free of the drug. Once that happens, you should be evaluated by a psychiatrist or mental health professional who is qualified to diagnose whether you are clinically depressed and need further drug therapy. Clinical depression often has a genetic basis and can require on-going use of antidepressants and other drugs.
If you have been abusing Lexapro, alcohol, prescription drugs or illegal drugs, and need help to learn a drug-free lifestyle, you might consider entering a residential treatment center for an intensive approach to your problems. It is not just about getting off drugs, but rather changing your life style so that your stress levels are appropriate and you no longer need to take drugs. Residential treatment offers a holistic approach to substance abuse. Sometimes you need to drop unhealthy relationships, find a new career or otherwise radically change your life, but these things are hard to do without professional advice and encouragement. The basis of residential treatment is an intense, one-on-one relationship with a trained therapist who guides you through your program. Besides intense psychotherapy, you might take workshops in stress-relief techniques such as yoga and meditation, discover new hobbies, and participate in other activities designed to help you get more in touch with your emotions and what you want out of life. Residential treatment should be fun, enlightening and a time of great self-discovery. Once you return home, you continue in an aftercare program with supportive therapists who help you maintain your new life style.