Escitalopram oxalate, often sold as Lexapro, is a commonly prescribed antidepressant medication used for the treatment of Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD). The Lexapro drug class belongs to a group of pharmaceutical substances referred to as Selective Serotonin Reuptake Inhibitors(SSRIs). SSRIs affect the levels of 5-hydroxytryptamine(5-HT) or Serotonin in the central nervous system, thus restoring its disbalance in disorders like generalized anxiety and major depression. This article tackles the mechanism of action of Lexapro generic Escitalopram, the indications for its use, Lexapro abuse, and addiction, as these are the most pertinent topics for patients and their families using Escitalopram.
Regardless of the popularity of SSRI use and their purported good safety profile, the incidence of Lexapro abuse can still be encountered.
What Is Lexapro (Escitalopram)?
Lexapro, and Lexapro generic Escitalopram, belong to a group of central nervous system-acting antidepressant medications known as Selective Serotonin Reuptake Inhibitors(SSRIs). SSRIs act by increasing the effects of Serotonergic transmission within the central nervous system by inhibiting CNS neuronal reuptake of 5-hydroxytryptamine(5-HT) or Serotonin. Thus, restoring the disbalance in the serotonergic activity that exists in mental disorders of Major Depressive Disorder(MDD) and General Anxiety Disorder (GAD).
Lexapro Generic and Brand Names
Each medication belonging to the group of SSRIs is available in both generic and brand forms. Escitalopram is no exception to this. The generic form of this substance is Escitalopram, while the two most common brand forms include Lexapro and Cipralex.
Lexapro Dosage Forms and Strengths
Escitalopram Is Available In Two Forms, Tablet and Oral Solution. The Specific Doses for Lexapro Medication Include:
- 5 mg Tablet, which comes in a bottle containing 100 tablets. The tablets themselves are white, round, non-scored, and film-coated. One side of the tablet contains the engraving “FL” and the other has number “5” on it.
- 10 mg Tablet, which also comes in a bottle containing 100 pills. The tablets themselves are white, round, scored, and film-coated. Engraving onto the scored side includes the letter “F” on the left while the letter “L” is on the right side. The engravement on the non-scored side contains the number “10”
- 20 mg tablets, also come in a bottle containing 100 pills. The tablets themselves are white, round, scored, and film-coated. Engraving onto the scored side includes the letter “F” on the left while the letter “L” is on the right side. The engravement on the non-scored side contains the number “20”
- The oral solution comes premixed as a 5mg per 5mL solution with peppermint flavor.
Generally, it is usually advised that SSRIs be started with the lowest dose and then gradually worked up to a higher dose. This is intended to find the ideal yet minimal dose that will help in reducing symptoms and signs of Major Depressive Disorder or Generalized Anxiety Disorder while minimizing the risk of Lexapro abuse, addiction, or overdose.
Escitalopram Drug Class
Lexapro drug class, as mentioned above, belongs to a group of CNS-acting antidepressant medications, referred to as Selective Serotonin Reuptake Inhibitor (SSRIs.) Escitalopram is an (S) enantiomer of another SSRI, Citalopram. This means that the compound contained in Escitalopram is “enantiopure”, containing only the most functional form, making it highly effective. Escitalopram mechanism of action is exerted on the Serotonin transporter(SERT) glycoprotein. It allosterically, meaning by binding to another-”allo” site-”steric”, inhibits the SERT, thereby upregulating the levels of Serotonin(5-HT) within the synapses, potentiating its effects. It is through this potentiating effect that SSRIs, like Escitalopram, are capable of treating the symptoms of Major Depressive Disorder(MDD) and Generalized Anxiety Disorder(GAD) which are associated with decreased levels of Serotonin within the central nervous system.
The exact dosage and regimen of administration are determined by a doctor, and it is imperative to stick to the dosage prescribed, and not to increase or reduce it without consultation.
Indication for Escitalopram Use
Lexapro Medication Is Approved By the FDA for Two Primary Mental Disorders:
- Acute and Maintenance Treatment of Major Depressive Disorder(MDD) in people over the age of 12.
- Acute Treatment of Generalized Anxiety Disorder(GAD) in people over 18.
In both of these conditions, one of the main etiologic or causative theories involves the altered levels of monoamines, of which serotonin is one, within the central nervous system. Escitalopram, as well as other SSRIs, restore the balance of serotonin, through which they alleviate the associated symptoms.
Escitalopram in Major Depressive Disorder (MDD)
The goal of Lexapro for depression is first to attain full remission of all the signs of symptoms of acute MDD, which includes:
- Persistent and prominent depressed mood that interferes with social or occupational functioning
- Anhedonia or loss of interest in usual activities
- Significant changes in weight and/or appetite
- Sleep disturbances
- Psychomotor agitation or retardation
- Fatigue
- Feelings of guilt or worthlessness
- Impaired concentration or slowed thinking
- Suicidal ideation and/or attempt.
Following treatment of acute symptoms for 8-12 weeks, and if an adequate response is achieved, Escitalopram use is usually switched to “maintenance” therapy, for a minimum of 6-12 months to reduce the risk of relapse.
Escitalopram in Generalized Anxiety Disorder (GAD)
Escitalopram is also used for the acute management of GAD. Generalized Anxiety Disorder is characterized by prolonged(>6 months), sustained anxiety or worry, that the patient finds difficult to control regarding a variety of events or activities relating to work, family, finances, or health. GAD is characterized by:
- Impairment in social and occupational functioning
- Diffuse sense of unpleasant sense of apprehension
- Restlessness and tremors
- Increased heart rate
- Chest pain
- Choking sensation
- Tingling sensation in arms and legs
- Dizziness and fainting
- Flushing
Off-Label Usage
Although Escitalopram is chiefly approved for the treatment of the aforementioned two conditions by the FDA, it may also be chosen to treat other mental disorders with the discretion of the prescribing physician.
These Conditions Include:
- Obsessive-Compulsive Disorder (OCD) characterized by repetitive anxiety-provoking thoughts/obsessions and repetitive behaviors/compulsions aimed at reducing anxiety.
- Social Anxiety Disorder characterized by severe anxiety in social interactions
- Posttraumatic Stress Disorder (PTSD) characterized by intrusive anxiety-provoking thoughts or imagery, hypervigilance, nightmares, and avoidance secondary to experiencing traumatic or life-threatening events.
- Premenstrual Dysphoric Disorder characterized by prominent mood(anxiety, depressed mood, irritability, insomnia, fatigue) and physical symptoms prior to menses in women.
- Premature Ejaculation can also be treated as SSRIs like Escitalopram can delay orgasm in some patients.
It is important to consider potential Escitalopram interactions when using this drug – patients should contact and discuss any drugs or supplements – such as other antidepressants, anticoagulants, alcohol, antibiotics, etc.. – they are taking with the prescribing physician before using the drug.
Furthermore, a common misunderstanding exists that Escitalopram can be used for the treatment of Alcohol dependence. This information is false, as Escitalopram is not approved for the treatment of Alcohol abuse or dependence by the FDA. What’s more, some studies have shown that treatment with any of the SSRIs can even cause alcohol dependence. Therefore, patients taking SSRIs should avoid alcohol consumption.
The question of “Is Lexapro a controlled substance” often arises. Escitalopram is classified as a non-controlled substance by the United States government, but its use still requires a prescription.
Lexapro Abuse Statistics
Motivation for Lexapro Abuse probably shared across all classes of antidepressants, is to achieve psychostimulant-like effects of euphoria. However, recreational or inappropriate use of prescription medications, including antidepressants, is an under-recognized problem, whose effects on public health have yet to be determined.
In addition, the extent of antidepressant misuse, which would include Lexapro abuse, is currently unknown as well. This is related to the fact that large-scale studies of prescription medication abuse do not include SSRIs and other antidepressant medications.
From what is known, FDA reports that Lexapro abuse liability is low based on animal studies and premarketing clinical trials. These, however, are not controlled systemic studies and do not exclude nor quantify the risk for Lexapro abuse.
Who is Most at Risk of Lexapro Abuse and Addiction?
As mentioned above due to the lack of organized systematic studies regarding Lexapro addiction and abuse, it is not clearly defined which group of people would be at increased risk for addiction. However, according to various behavioral science studies, certain age groups and people with specific risk factors in their past medical history can be at an increase for overall substance use disorders, which would also be applicable to Escitalopram.
People with the following risk factors would be most susceptible to Lexapro addiction and abuse:
- Family or personal history of addiction and substance abuse, such as alcohol, opioids or benzodiazepines.
- Current or past incidence of mood disorders such as depression or anxiety
- Coping with difficulties in the family such as neglect, lack of support, marital discord, and unemployment
- Regular contact with a social environment where substance abuse is accepted
Signs and Symptoms Of Escitalopram Addiction And Abuse
There are no specific signs and symptoms related to only Lexapro addiction and abuse, but there are certain behavioral and psychological tell-tale signs that can be identified in patients with substance use disorders:
- Failing to fulfill obligations at work, school, or home
- New or worsening social or interpersonal problems
- Social, occupational, or recreational activities are given up or reduced
- Frequent lying, anxiety and stress regarding Escitalopram use
- Use of the substance in larger amounts or for a longer period than prescribed
- Persistent desire or unsuccessful efforts to cut down or control use
- Great deal of time spent on activities necessary to obtain, use, or to recover from the effects of Escitalopram.
- Craving or a strong desire for Escitalopram
- Stealing or forging of prescriptions for Escitalopram
- “Doctor Shopping” or contact with multiple doctors to obtaining multiple prescriptions
- “Risky Use” or the use of Escitalopram in situations in which it is hazardous to one’s health.
- Continued use of Escitalopram despite physical health or psychological problems.
Furthermore, patients who abuse Escitalopram are likely to develop adverse signs and symptoms related to their physical health as well, which can include:
- Labile mood
- Difficulty falling or staying asleep at night
- Sexual dysfunction and loss of libido
- Problems with mentation and memory
Treating Lexapro Addiction
Treatment of Lexapro Addiction is complex and patients often need the help and guidance of medical health professionals to achieve sobriety. The discontinuation of the Escitalopram should follow a regimen that involves a gradual decrease in the dosage of Escitalopram administered, in order to prevent Lexapro withdrawal. In addition to gradual drug discontinuation, psychological help and support or admittance to a rehab facility may be necessary.
Lexapro overdose, related to its addiction, is a medical emergency that requires admittance to an emergency room in most cases and subsequent support and management.
Frequently Asked Questions
What Is the Best Time to Take Lexapro?
There is no “best time” to take this medication. It is important to take it at the same time every day as prescribed by your physician.
Is Lexapro an Maoi?
Lexapro is not a Monoamine Oxidase Inhibitor(MAOI), it is a Selective Serotonin Reuptake Inhibitor(SSRI) as described in detail above.
Is Lexapro Addictive?
Addiction and dependence can be of two types, Physiological and Psychological. Substance addiction and dependence are associated with drugs that have primary or secondary/passive effects on dopaminergic circuits in the brain. Since Lexapro drug class is of selective serotonin reuptake inhibitors it can be assumed that it has little to no effect on dopaminergic transmission, and thus its liability for either type of addiction/dependence is low.
Is Lexapro a Controlled Substance?
Lexapro is not a controlled substance. Controlled substances are ones whose production, use, handling, storage, and distribution are controlled by the government due to their high potential for abuse or cause addiction. Since the potential for Escitalopram addiction and abuse is viewed as low, it is not considered a controlled substance.
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