Lexapro Side Effects in the First Week: What to Report

The Lexapro (escitalopram) label never pins side effects to a specific week. So if we're being honest about what the first week looks like, the best we can do is describe what people reported most often in clinical trials. The FDA label for Lexapro puts trouble sleeping, delayed ejaculation, nausea, more sweating, tiredness, sleepiness, lower sex drive and trouble reaching orgasm at the top of the list. In the generalized anxiety disorder trials, headache also beat placebo rates. For a lot of people, side effects arrive before any benefit does. A few symptoms are a different story. New or worse depression or suicidal thoughts, signs of serotonin syndrome, unusual bleeding or bruising, and signs of low sodium such as confusion or weakness — each of these warrants a call to your prescriber right away. Here are both lists, along with what your follow-up visit is actually for.

Important safety information

> Lexapro (escitalopram) and other antidepressant medicines may increase suicidal thoughts or actions in some children, teenagers and young adults (24 years of age and younger), especially within the first few months of treatment or when the dose is changed. Watch closely for new or sudden changes in mood, behavior, thoughts or feelings, and call your prescriber right away if you notice them. > > If you or someone you know is thinking about suicide or is in crisis, call or text 988, or chat at 988lifeline.org, to reach the 988 Suicide & Crisis Lifeline. It's free, confidential and available 24/7. If someone is in immediate danger, call 911.

Which side effects came up most in Lexapro's clinical trials?

In Section 6, the Lexapro label spells out which side effects turned up more often on Lexapro than on placebo in the studies that led to its approval:

• Trouble sleeping. Some people find it harder to fall asleep or stay asleep after starting.
• Sleepiness and tiredness. The opposite problem appears on the same list, because different bodies respond differently — some people feel wired, others feel drained.
• Nausea. One of the most frequently reported reactions in the trials.
• More sweating.
• Sexual side effects. Delayed ejaculation, lower sex drive and trouble reaching orgasm were all more common on Lexapro than on placebo.
• Headache. In the generalized anxiety disorder trials, headache was also more common than on placebo.

Two things are worth holding onto here. First, a trial list describes what happened across a group of people; it is not a forecast of what will happen to you. Plenty of people start Lexapro and notice very little. Second, the label gives no timetable — it doesn't say how long any of these last, and neither will we. Many people find that early side effects become less noticeable as their body adjusts, but there is no guarantee, and "wait and see" has a limit. If a side effect is making your life worse, say so. That isn't complaining; it's exactly the information your prescriber needs.

A note on the sexual side effects, because they're the ones people most often keep to themselves: prescribers hear about them constantly, and they are on the label precisely because they're common. There is nothing embarrassing about raising them. Staying quiet just means your prescriber is working with incomplete information.

Why do side effects usually show up before the benefits?

Because they run on different clocks. The medication is in your body from the first dose, and side effects tend to track with its presence. The benefits — steadier mood, less of the constant worry — depend on slower changes in how your brain responds, and they generally take longer to appear. We've written a fuller explanation of that gap in how long antidepressants take to work.

That gap matters because it is lopsided in the least encouraging direction: early on, you may be getting the costs of the medication before any of the payoff. Knowing that in advance changes what the first days mean. Nausea on day four is not evidence that the medication has failed; it's the part of the timeline everyone was told to expect. The fair moment to weigh whether Lexapro is helping is a follow-up visit with your prescriber, as part of your overall treatment for depression or treatment for anxiety — not alone at 2 a.m. in the first week.

One important exception: if what you're feeling isn't a nuisance side effect but a genuinely worsening mood, growing anxiety, or thoughts that scare you, do not wait it out. We've written about what to do if you feel worse after starting a psychiatric medication, and the list below spells out when to pick up the phone.

When should I call my prescriber right away?

The Lexapro Medication Guide asks patients — and the people around them — to call the prescriber right away if any of the following show up, especially if they are new, worse, or worrying:

• Thoughts about suicide or dying
• Attempts to commit suicide
• Acting on dangerous impulses
• Acting aggressive, angry or violent
• New or worse depression
• New or worse anxiety
• Panic attacks
• Feeling very agitated or restless
• New or worse irritability
• Trouble sleeping
• An extreme increase in activity or talking (mania)
• Other unusual changes in behavior or mood

You may notice trouble sleeping appears on both lists in this article. On its own, it's one of the most common nuisance side effects; alongside changes in mood or behavior, it's part of a pattern your prescriber needs to hear about. When in doubt, call — nobody at the other end of that line will think you're overreacting. An extreme increase in activity or talking can be a sign of mania, which is one of the reasons prescribers ask about any personal or family history of bipolar disorder before starting an antidepressant.

The Lexapro label's warnings add three more reasons to call right away:

• Signs of serotonin syndrome, which can include agitation, confusion, a racing heart, fever, heavy sweating, muscle stiffness or twitching, nausea, vomiting or diarrhea
• Unusual bleeding or bruising
• Signs of low sodium, such as confusion or weakness

Families and caregivers should watch for these changes too. And keep all follow-up visits, even the ones that feel unnecessary because things seem fine — those visits are where small problems get caught while they're still small.

Can I just stop taking Lexapro if the side effects bother me?

No — not without talking to your prescriber first. The label warns that stopping Lexapro suddenly can cause discontinuation symptoms, which may include irritability, agitation, dizziness, electric-shock-like sensations, anxiety, headache and trouble sleeping. In other words, quitting abruptly can hand you a second set of symptoms on top of the first.

If a side effect is intolerable, that's a phone call, not a decision to make alone. Prescribers have ways to respond — adjusting the plan, changing when you take the medication, tapering off safely, or switching to something else — and which one makes sense depends on details only a conversation can sort out. The rule worth keeping for every psychiatric medication, not just this one: never start, stop or switch a medication on your own.

What is the follow-up visit actually for?

A follow-up after starting an antidepressant is standard practice, and it has a specific job: it's where the early evidence gets weighed. Expect your prescriber to ask about the items on the call-right-away list, about the common side effects and how tolerable they've been, about sleep, appetite and energy, and about any early signs of change in the symptoms Lexapro was prescribed for.

You can make that visit far more useful with five minutes of preparation. Jot down what you've noticed and roughly when — "nausea most mornings, better by lunch" tells your prescriber more than "I felt a bit off." Bring your questions too, including the small practical ones: the label, for instance, states that drinking alcohol while taking Lexapro is not recommended, and questions about timing, food and alcohol are exactly what the visit is for.

If you're already taking Lexapro and quietly wondering whether it's the right fit, that question deserves a visit of its own rather than a search bar. You can read about the psychiatric clinicians on our team, look over our self-pay rates and the insurance we accept, and get started with booking a visit whenever you're ready.

What about teens starting Lexapro?

For teens: Lexapro is FDA-approved for depression in ages 12 and up and for generalized anxiety disorder in ages 7 and up. The boxed warning at the top of this article applies with particular force here — the increased risk of suicidal thoughts and actions was observed in people 24 and younger, especially within the first few months of treatment or when the dose is changed. That makes the watching part a family job: parents and caregivers should know the call-right-away list above as well as the teen does, and should never hesitate to use it. MindVibe sees patients 13 and older.

Frequently asked questions

Do Lexapro's early side effects go away?

The label doesn't say — it reports which side effects were most common in clinical trials, not how long they lasted. Many people find early side effects become less noticeable as their body adjusts, but that's a tendency, not a promise. If a side effect isn't fading or is hard to live with, tell your prescriber rather than waiting indefinitely or stopping on your own.

Is it normal to feel more anxious right after starting Lexapro?

New or worse anxiety is on the Medication Guide's list of things to report right away, so don't treat it as something to ride out quietly. It may turn out to be minor, but that's your prescriber's judgment to make, not yours to guess at. Call and describe what changed and when it started.

What does serotonin syndrome feel like?

According to the Lexapro label, signs can include agitation, confusion, a racing heart, fever, heavy sweating, muscle stiffness or twitching, nausea, vomiting and diarrhea. It is a reason to contact your prescriber right away — and if symptoms are severe, such as high fever, seizures or marked confusion, to seek emergency care.

Will the sexual side effects be permanent?

No one can promise what any side effect will or won't do, but lower sex drive, delayed ejaculation and trouble reaching orgasm were among the most common side effects in Lexapro's trials, which means prescribers deal with them routinely. Raise it at your visit — there are ways to respond, and the worst strategy is staying silent or stopping the medication on your own.

Should I take Lexapro in the morning or at night?

Follow your prescriber's instructions. Both trouble sleeping and sleepiness showed up in the trials, which is part of why timing is individualized — some people do better taking it at one end of the day than the other. If you suspect the timing is working against you, ask your prescriber before changing anything.

Can I drink alcohol while taking Lexapro?

The FDA label states that the use of alcohol by patients taking Lexapro is not recommended. If drinking is part of your routine, bring it up honestly at your visit so your prescriber can give advice that fits your actual life.

How long until I know whether Lexapro is working?

Longer than it takes to know about side effects, which is the frustrating part. Benefits generally appear more gradually, and the first fair checkpoint is the follow-up visit your prescriber schedules, not the first few days. If you feel worse rather than simply not better yet, don't wait for that visit — use the call-right-away list in this article.

This article is for educational purposes only and is not medical advice. It does not replace a conversation with your own prescriber or a psychiatric provider, and it is not a recommendation to start, stop or change any medication. Always talk with your prescriber about your specific situation.